QUINCKE’S TRIAD: SEQUELAE OF TRAUMATIC LIVER INJURY.

Faiz Najmuddin GHAZI^1,2 , Ikhwan Sani MOHAMAD^1,2 ,Wan Mokhzani WAN MOKHTER^1,2 ,  Chandran NADARAJAN^2,3 , Mohd Shafie ABDULLAH^2,3

¹Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan ,Malaysia.

²Hospital Universiti Sains Malaysia, 16150, Kubang Kerian ,Kelantan , Malaysia.

³Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.

ABSTRACT

Quincke’s triad is characterized by upper abdominal pain, jaundice, and upper gastrointestinal (GI) bleeding. It represents a rare complication following traumatic liver injury. Here we reported a classical case of Quincke’s triad as a sequelae of blunt liver injury in a 14-year-old girl following involvement in a motor vehicle accident. She sustained a grade 3 liver injury, grade 2 right renal injury and right adrenal hematoma. She was initially managed conservatively in view of her haemodynamic stability but developed upper GI bleeding on 3^rd week of admission with severe right upper quadrant abdominal pain and jaundice. An urgent esophagogastroduodenoscopy was performed which revealed the presence of blood within the upper gastrointestinal tract but no primary source of the bleeding was identified. A Contrast-enhanced computed tomography of the abdomen revealed dilated biliary tree with the presence of filling defect within suggestive of blood clot in common bile duct. A subsequent scan following a recurrent bleed revealed a right hepatic artery pseudoaneurysm which was successfully managed with endovascular coil embolization.

Keywords: Gastrointestinal haemorrhage, Haemobilia, Liver injury, Jaundice, Quincke’s triad.

Correspondence: Ikhwan Sani MOHAMAD, Department of Surgery, Universiti Sains Malaysia, Kubang Kerian,16150 Kota Bharu, Kelantan, Malaysia

Email: ikhwansani@yahoo.com.my

Brunei Int Med J. 2020;16:24-28