Echo Free Space in Morrison’s Pouch in a Patient with Traumatic Bladder Rupture: A Case Report

Ultrasonography is a useful emergency room technique for detection of abdominal hemorrhage in trauma patients. In the JATEC course(Japan Advanced Trauma Evaluation and Care course),FAST (Focused Assessment of Sonography for Trauma)is advocated to determine the presence of a fluid pool, especially hemorrhage,in the pericardial,thoracic,and abdominal cavities. Most clinicians are initially likely to regard fluid as hemorrhage from the abdominal organs,but the fluid may also be derived from blood,ascites,urine,or other fluids. We report a 39-year-old man who suffered a bruise to his lower abdomen in a traffic accident. He underwent ultrasonography,and an echo free space was found in his Morison’s pouch. Intraabdominal hemorrhage was suspected,but a CT scan did not show any multiple organ injury,but the bladder was ruptured. The fluid in the abdominal cavity was urine derived from this bladder rupture. The cause of FAST positivity,except for hemorrhage,is thought to be a blind spot for clinicians;however,causes other than hemorrhage need to be considered,especially in patients with trauma to the lower abdominal region.(Kitakanto Med J 2008;58:217~219)