Delayed Small Bowel Obstruction after Blunt Abdominal Trauma. A Case Report

Chatzis, Iosif; Katsourakis, Anastasios; Noussios, George; Chouridis, Pantelis; Chatzitheoklitos, Efthimios

doi:10.1080/00015458.2008.11680295

Cited by 10 publications

(13 citation statements)

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“…The pathologic mechanism of these delayed obstructions was suspected of resulting from traumatic intramural inflammation and fibrosis due to mesenteric injuries, seromuscular and intramural injury, and microscopic hemorrhage. 7,8 The delayed duodenal obstruction in our case was thought to be caused by the same mechanism.…”

Section: Discussionsupporting

confidence: 53%

“…Although previous reports of delayed traumatic duodenal obstruction without macroscopic intramural or extraluminal hematoma cannot be found, case reports of small intestinal delayed traumatic obstruction without macroscopic hematoma were noted. 7,8 In some of these cases, the interval between injury and symptom was 3 months, such as in our case. The pathologic mechanism of these delayed obstructions was suspected of resulting from traumatic intramural inflammation and fibrosis due to mesenteric injuries, seromuscular and intramural injury, and microscopic hemorrhage.…”

Section: Discussionmentioning

confidence: 58%

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A Case of Delayed Duodenal Obstruction Due to Traumatic Fibrosis Following Seromuscular and Intramural Injury

Moriwaki

Arata

Toyoda

et al. 2018

International Surgery

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Objective: Traumatic duodenal obstructions are rare, and most are caused by compression from intramural or retroperitoneal macroscopic hematomas. This report describes a very rare type of delayed traumatic duodenal obstruction without macroscopic intramural or extraluminal hematoma caused by traumatic fibrosis due to seromuscular and intramural injury and microscopic hemorrhage. Case presentation: A 31-year-old man was transferred to our center due to polytrauma with nausea and vomiting on day 53 after an accident. Gastrointestinal fiberscopy (GIF) on day 57 revealed an active stage small duodenal ulcer with patency of the pyloric ring. Although the patient underwent subdural drainage, the nausea and vomiting continued. A repeat GIF on day 91 revealed a duodenal ulcer with severe pyloric stenosis. GIF after nasogastric drainage on day 102 identified a severe pinhole stenosis. We performed surgery on day 106 and observed a constricted duodenal bulb due to a tumorous scar. We resected the stenotic section of the duodenal bulb including the pyloric ring. Conclusion: The histopathologic examination revealed constriction and fibrosis. Surgical options should be considered for patients with delayed duodenal obstruction without macroscopic hematoma around the duodenum after several months of hospitalization.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 58%

A Case of Delayed Duodenal Obstruction Due to Traumatic Fibrosis Following Seromuscular and Intramural Injury

Moriwaki

Arata

Toyoda

et al. 2018

International Surgery

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“…13 Small tears and contusions in the mesentery may cause partial thickness ischaemia of the bowel wall, with mucosal ulceration and submucosal inflammation and fibrosis, or full-thickness ischaemia with fibrosis of all layers. 5 Meanwhile, intramural haematoma of the small bowel is a rare cause; the presumed mechanism of this condition is a shearing of the layers of the bowel wall, which then tears the submucosal vascular bed. 7 Posttraumatic SBO characterised by delayed onset of obstruction can be confirmed relatively easily by an upper gastrointestinal series, which usually adds further information about the location and narrowing of the bowel lumen.…”

Section: Discussionmentioning

confidence: 99%

Nonoperative management for delayed bowel obstruction after blunt abdominal trauma: A case report

et al. 2010

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“…On the other hand, it has been reported that bowel necrosis and the surgical resection of gangrenous lesions can be avoided if the condition is identified quickly and the cause is determined at an early stage [ 8 ]. Although bowel stenoses that present after non-surgical treatment have been demonstrated in patients with abdominal trauma [ 16 , 17 ], inflammatory enterocolitis, and ischemic enterocolitis [ 18 - 20 ], there are no specific reports or guidelines that describe the management and follow up of patients with NOMI in whom bowel necrosis and surgical treatment have been avoided.…”

Section: Introductionmentioning

confidence: 99%

Delayed intestinal stricture following non-resectional treatment for non-occlusive mesenteric ischemia associated with hepatic portal venous gas: a case report

et al. 2015

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BackgroundHepatic portal venous gas associated with non-occlusive mesenteric ischemia is indicative of a serious pathology that leads to bowel necrosis and it has a high mortality rate. Although non-occlusive mesenteric ischemia is acknowledged as a condition that requires early surgical treatment, it has been reported that bowel necrosis and surgical resection of the gangrenous lesion may be avoided if the condition is identified quickly and the cause is detected at an early phase. However, no reports or guidelines have been published that describe the management of patients in whom bowel necrosis and surgical treatment were avoided. We report the case of a patient who presented with non-occlusive mesenteric ischemia who was managed with non-resectional treatment at an early phase and had a delayed small-bowel stricture.Case presentationA 24-year-old man presented to the hospital with fever, abdominal pain, and vomiting. Abdominal computed tomography confirmed a diffuse gaseous distention with small-bowel pneumatosis and hepatic portal venous gas. An urgent laparotomy was performed, because septic shock associated with diffuse peritonitis and bowel necrosis was strongly suspected. Although we found purulent ascites and a perforated appendix at the time of surgery, gangrenous and transmural ischemic changes were not evident in the small bowel and colon. We performed an appendectomy without a bowel resection, and the patient was discharged on an oral diet. However, he was re-admitted to hospital, because 4 days after discharge he developed postoperative paralytic ileus. Non-operative management was chosen, but his symptoms did not improve. We decided to perform a laparotomy 40 days after the initial operation, and a considerable adhesion was detected. Therefore, only a synechotomy was performed. On day 57, he experienced symptoms that were associated with bowel obstruction once again. On day 59, a partial resection of the jejunum was performed. Severe luminal strictures were apparent within the jejunum, and marked structural changes were evident.ConclusionWhile non-surgical management can be chosen for selected patients with non-occlusive mesenteric ischemia, continuous observation to evaluate the development of delayed strictures that lead to bowel obstructions is required in patients who undergo non-resectional treatment.

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Delayed Small Bowel Obstruction after Blunt Abdominal Trauma. A Case Report

Cited by 10 publications

References 0 publications

A Case of Delayed Duodenal Obstruction Due to Traumatic Fibrosis Following Seromuscular and Intramural Injury

A Case of Delayed Duodenal Obstruction Due to Traumatic Fibrosis Following Seromuscular and Intramural Injury

Nonoperative management for delayed bowel obstruction after blunt abdominal trauma: A case report

Delayed intestinal stricture following non-resectional treatment for non-occlusive mesenteric ischemia associated with hepatic portal venous gas: a case report

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