However, given its rarity, there is a lack of established guidelines for monitoring and follow-up of isolated adrenal trauma in the literature. It is important for the clinician to be aware that acute adrenal haemorrhage could be secondary to a traumatic insult, or from a pre-existing adrenal lesion. Although mostly self-limiting, acute adrenal injury can be life-threatening if it represents a significant cause of bleeding or hypotension, or results in bilateral injury which increases the risk of adrenal insufficiency or adrenal crisis.Ĭontrast-enhanced computed tomography (CT) of the abdomen remains the gold standard in distinguishing adrenal haematomas from incidental adenomas in the setting of trauma. Because unilateral adrenal injury is typically a benign condition, management is generally conservative with analgesia and observation, whereas surgery is usually indicated for associated injury to other internal organs, including the spleen, kidneys, bowel, liver, or ribs. In the setting of trauma, adrenal injury can point to other concomitant injuries and is associated with increased morbidity and mortality. Adrenal gland injury is rare due to its small size, deep retroperitoneal position, and presence of fatty tissue surrounding it however, the adrenal glands are vulnerable to bleeding due to their extensive network of collateral circulation. Due to its unique anatomy and the mechanism required to result in an isolated injury, adrenal injury is typically unilateral and right-sided. Isolated trauma to the adrenal gland is a rare and underreported injury, with an incidence of between 1.5% and 4% of all adrenal trauma cases. The current consensus appears to be appropriate with conservative management and follow-up with serial abdominal CT until the resolution of haemorrhage and/or symptoms. Post-traumatic isolated left adrenal gland injuries are rare in the reported literature, and this case highlights the lack of current guidelines for management and monitoring in cases of isolated adrenal haemorrhage. Follow-up CT of the adrenals at five months post-injury demonstrated complete resolution of the isolated adrenal haematoma. At a six-week follow-up, he reported a complete resolution in symptoms. He was admitted to the ward for observation and discharged on day three of admission. Initial assessment revealed tenderness in the left upper quadrant with normal vital signs and biochemistry, but computer tomography (CT) imaging demonstrated an enlarged left adrenal gland with regional fat stranding and free fluid consistent with an acute adrenal haematoma. A 39-year-old man presented with mild abdominal pain following a mountain bike accident. We present a case report of a rare, isolated, post-traumatic left adrenal gland haemorrhage. Due to its rarity, there are currently no established guidelines for management, monitoring, or follow-up of adrenal gland trauma. While acute, unilateral adrenal injuries can be asymptomatic, it is important to recognise the potentially life-threatening complications from haemorrhage and/or adrenal insufficiency. Most traumatic injuries are right-sided and associated with other concurrent organ injuries. Isolated left adrenal gland injuries following blunt abdominal trauma are extremely rare, accounting for only 1.5-4% of all adrenal trauma cases.
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