Delayed Presentation of Complete Ileal Transection Following Blunt Trauma Abdomen: A Condition to Cognize

Abstract

Isolated small bowel perforation is a rare presentation of blunt abdominal trauma, and most cases present immediately following the trauma. Delayed presentation of such cases beyond one week of trauma is extremely rare, and various pathophysiological mechanisms were described for the same. We present a 20-year-old male patient who sustained blunt abdominal and pelvic trauma, underwent open reduction and internal fixation for right acetabular fracture, and later developed features of acute peritonitis after one month. On laparotomy, complete terminal ileal transection was found and an ileostomy was done. Delayed perforation of the intestine following trauma occurs due to ischemic necrosis, either through direct trauma to the intestinal wall or indirectly by injury to the mesenteric vessels. Direct trauma to the bowel can result in large hematomas on the bowel wall, which can later perforate due to ischemia. Surgeons should be aware of this rare presentation as the management is challenging and it poses significant medico-legal sequel. Close monitoring of the patient’s vitals and examination for the development of abdominal signs along with repeat imaging at the onset of abdominal signs are cornerstones for successful management of these patients.

The novel use of resuscitative endovascular balloon occlusion of the aorta for uncontrolled bleeding in a surgically inaccessible abdomen: The ruptured proper hepatic artery in a frozen abdomen

“…The cause of delayed injury to the duodenum in our patient may be multifactorial. In the setting of trauma, delayed intestinal perforation is rare, but can be caused by ischemic necrosis secondary to mesenteric vessel injury or direct damage [ 8 , 9 ]. Due to the patient's frozen abdomen, the exact timing of the duodenal perforation is unclear.…”