Chronic Myeloid Leukaemia Presenting as Traumatic Haemoperitoneum and Duodenal Injury

Abstract

A 13-year-old boy presented with an acute abdomen after a dubious blunt abdominal injury. Evaluation at the accident and emergency department revealed the presence of haemoperitoneum. CT scan and a subsequent duodenography confirmed an accompanying duodenal hematoma and splenomegaly, but no solid organ injury was detected. As the child remained haemodynamically stable, a conservative management was adopted. Leucocytosis and thrombocytopenia were found on further investigation, which led to a final diagnosis of Philadelphia chromosome positive chronic myeloid leukaemia. We speculate that the underlying haematological malignancy in this case might have contributed to the florid intra-abdominal signs of injury. A careful search for a systemic illness would be useful in the management of childhood abdominal trauma, especially when the account of injury is dubious or apparently trivial.