A Case of Small Bowel Obstruction and Enterocutaneous Fistulation Resulting from a Mesenteric Haematoma following Blunt Abdominal Trauma

Abstract

A 23-year-old male with a history of previous abdominal surgery was involved in a road traffic accident. He was discharged after initial assessment but represented several days with small bowel obstruction secondary to a mesenteric haematoma. He underwent resection and recovered well but represented later on the day of discharge with a leaking surgical wound consistent with an enterocutaneous fistula. This was managed conservatively and closed spontaneously after ten days. This case serves to highlight that adhesions from previous surgery can tether the small bowel causing mesenteric injury following blunt-force trauma. It also demonstrates that postoperative ileus can result in an enterocutaneous fistula that has the appearance of an anastomotic breakdown but which resolves more rapidly.

Small Bowel Obstruction

“…Intramural hematomas or mesenteric hematomas are not infrequent causes of postoperative obstructive symptoms with the jejunum and ileum as the most common sites in the small bowel 10 and can also be seen following abdominal trauma, particularly blunt trauma. [11][12][13] Patients on anticoagulation or antiplatelet therapy, or with conditions such as hemophilia or thrombocytopenia, have also been described to have spontaneous hematomas. 10,[14][15][16] Even connective tissue disorders, such as Ehlers-Danlos syndrome, may increase the risk of spontaneous intramural hematomas.…”