Mild Abdominal Trauma in Patients With Crohn's Disease: Greater Susceptibility to Colon Perforation?

Pérez-Jiménez, Aida; Serna, Sofía de la; Palomar, Jorge; Sanz-Ortega, Gonzalo; Torres, Antonio

doi:10.1016/j.cireng.2019.12.004

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…It has been reported that relatively minor trauma in patients with CD can result in gastrointestinal injury. To the best of our knowledge, only 11 cases of traumatic intestinal injury have been reported [7][8][9][10][11][12][13][14][15]. All cases are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Damage to the Descending Colon after Endoscopic Balloon Dilatation following a Minor Traffic Accident in a Patient with Crohn’s Disease: A Case Report

Seki,

Osone,

Ogawa

et al. 2024

Case Rep Gastroenterol

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Introduction: Crohn’s disease (CD) is complicated by intestinal strictures and fistula formation; however, intestinal perforation is relatively rare. Case Presentation: Following a traffic accident in the evening, a 39-year-old woman experienced abdominal pain that worsened the following morning and was taken to the emergency department. She had a 17-year history of CD and eight endoscopic balloon dilations for descending colonic strictures. She presented with a high fever of 40.0°C, along with tenderness and rebound pain throughout her abdomen, with the most substantial point being in the lower left abdomen. Computed tomography showed thickening of the descending colon wall, increased fat concentration around the wall, and a slight presence of air in the mesentery near the intestinal wall. We diagnosed the patient with generalized peritonitis due to traumatic penetration of the mesentery of the descending colon and performed emergency surgery. Intraoperative observation of the abdominal cavity with a laparoscope revealed purulent ascites but no apparent perforation or edematous mesentery, with white moss and redness in the descending colon. This prompted the decision to perform peritoneal lavage drainage and a transverse colonic double colostomy. The postoperative course was favorable, and the patient was discharged from the hospital on the postoperative day 14. Four months after discharge, colostomy closure was performed. Conclusion: Relatively minor trauma in patients with CD can result in colon injury. An injured bowel is usually accompanied by active lesions due to CD; however, caution is required, as endoscopic balloon dilatation without accompaniment may be a background factor.

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Section: Discussionmentioning

confidence: 99%

Damage to the Descending Colon after Endoscopic Balloon Dilatation following a Minor Traffic Accident in a Patient with Crohn’s Disease: A Case Report

Seki,

Osone,

Ogawa

et al. 2024

Case Rep Gastroenterol

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“…Due to these findings, an urgent laparotomy was indicated, and a 2-cm perforation in the hepatic angle was found intra-operatively, which indicated a right hemicolectomy to be performed. This patient developed a surgical-site infection and intraabdominal collection afterward and was discharged on the 30-day PO [7].…”

Section: Discussionmentioning

confidence: 99%

Mild Abdominal Trauma Complicated With Bowel Perforation in Patient With Crohn’s Disease: Clinical and Intraoperative Findings

Babiker¹,

Alkharraz²,

Alsaeed³

et al. 2022

Cureus

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Crohn's disease (CD) is a chronic inflammatory disease and is an autoimmune disorder. Due to its remission and relapse cycle, the integrity of the intestinal wall becomes compromised in patients with inflammatory bowel disease. This increases susceptibility to bowel perforation following mechanical injury, especially in patients using immunosuppressive therapy. However, few reports discuss the severity of injury after abdominal trauma in Crohn's patients and how much mild abdominal blunt trauma in such patients can be different in the presentation clinically in correlation with the severity of the intraoperative findings. We report a case of ascending colon perforation secondary to mild abdominal blunt trauma in a patient with CD.Categories: General Surgery Keywords: post operative (po), junction between the cecum and ascending colon (jbcac), low intensity blunt trauma (libt), crohn's disease (cd), computed tomography (ct )

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“…However, spontaneous intestinal perforation remains a rare occurrence among them, accounting for 1–3% of all spontaneous intestinal perforation ( 3 , 4 ). The diagnosis of intestinal perforation can be commonly missed in CD patients ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Dilemma of Blunt Abdominal Trauma in Patients with Crohn’s Disease, Can Intestinal Perforation be Missed?

Foula¹,

Boumarah²,

Alabbad³

et al. 2023

Med Arch

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Background: Isolated intestinal injury after blunt abdominal trauma is a rare challenging clinical entity. Patients with Crohn’s disease (CD) are considered more prone to spontaneous intestinal perforation rather than normal population However, spontaneous intestinal perforation remains rare. In the literature, there are few cases reports discussing intestinal perforation after blunt abdominal trauma in CD patients. Objective: Herein, we report a young male patient with CD who had missed traumatic intestinal perforation along with literature review of similar cases. Case Presentation: A young male patient, known to have CD, was brought to the emergency department after a road traffic accident. He had mild tenderness over his right iliac fossa with no signs of peritonitis. His chest X-rays revealed right-sided pneumothorax. His pan-computed tomography revealed thickened terminal ileum and minimal collection between the intestinal loops that were interpreted as interval regression of his Crohn’s disease. On the second day, he remained hemodynamically-stable with no signs of peritonitis but his chest X-rays showed air under diaphragm. A repeated CT showed pneumoperitoneum, air foci around the terminal ileum and mild free fluid. An ileal perforation was found around 25 cm from the ileo-cecal valve. The involved ileal segment was completely resected with double-barrel ileostomy. Conclusion: Traumatic intestinal injury in patients with Crohn’s disease represent both diagnostic and management dilemma. Inaccurate interpretation of radiological signs may lead to a delayed or missed diagnosis and surgical intervention. Abdominal CT scan should be routinely repeated, within 24 hours, for such patients, regardless absence of symptoms or signs suggestive of intestinal perforation.

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Mild Abdominal Trauma in Patients With Crohn's Disease: Greater Susceptibility to Colon Perforation?

Cited by 4 publications

References 8 publications

Damage to the Descending Colon after Endoscopic Balloon Dilatation following a Minor Traffic Accident in a Patient with Crohn’s Disease: A Case Report

Damage to the Descending Colon after Endoscopic Balloon Dilatation following a Minor Traffic Accident in a Patient with Crohn’s Disease: A Case Report

Mild Abdominal Trauma Complicated With Bowel Perforation in Patient With Crohn’s Disease: Clinical and Intraoperative Findings

Dilemma of Blunt Abdominal Trauma in Patients with Crohn’s Disease, Can Intestinal Perforation be Missed?

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