Traumatic Lesions of the Intestine Caused by Nonpenetrating Blunt Force

Vance, B. M.

doi:10.1001/archsurg.1923.01120010200011

Cited by 27 publications

(20 citation statements)

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“…4 Crushing of the colonic segment between two objects, rapid deceleration and burst injury in response to increase intra-luminal pressure are the probable mechanisms. 5 The rate of complications associated with colon injury is significantly higher if the duration is longer than 24 h after the injury. 6 Plain radiographs are not reliable in detecting the presence of a significant injury, they appear normal in most cases.…”

Section: Discussionmentioning

confidence: 99%

A rare case of isolated transverse colon perforation following blunt trauma abdomen-case report with review of literature

2015

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Section: Discussionmentioning

confidence: 99%

A rare case of isolated transverse colon perforation following blunt trauma abdomen-case report with review of literature

2015

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“…[3][4][5] Morbidity and mortality due to delayed diagnosis occur as a result of haemorrhage of injured mesenteric vessels and peritonitis from bowel wall rupture or bowel ischaemia. Patients with a slow oozing mesenteric haematoma may remain clinically undetected for days, until bowel necrosis occurs leading to peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric injury caused by minor blunt abdominal trauma

Rf¹,

et al. 2006

Emergency Medicine Journal

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The authors present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and also provide a review of the literature. M esenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. 1 It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. 2 We present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and go on to provide a thorough review of the literature. CASE REPORTA 63 year old male presented to the emergency department with progressive, dull epigastralgia for two days. He reported that the pain was a result of blunt abdominal injury from being hit by his 3 year old grandson's head while playing. His family witnessed the scenario and stated that the patient was fine except for mild abdominal pain after the collision. There was no significant past medical history. His vital signs on presentation were blood pressure 92/50 mm Hg, heart rate 94 beats/minute, respiratory rate 22 breaths/minute, and temperature 35.9˚C (96.2˚F). Physical examination was remarkable only in the abdomen which was distended and diffusely tender to palpation. Laboratory tests showed a haematocrit of 38.6%, serum creatinine 1.5 mg/dl, and amylase 64 U/l. The coagulation profile was within normal limits. A rapid trauma sonography demonstrated free intraperitoneal fluid.After stabilisation of his vital signs, a contrast enhanced abdominal computed tomography (CT) was obtained, which showed the presence of ascites and mesenteric haematoma (fig 1). Internal bleeding was confirmed by peritoneocentesis which yielded bloody fluid and the patient was then sent to the theater for an emergent celiotomy. Intraoperative findings revealed the presence of up to one litre of bloody ascites and a stable mesenteric haematoma adjacent to the Treitz ligament. Surgical repair was performed. The spleen, pancreas, liver, duodenum, and small and large bowels were all intact. The postoperation course was uncomplicated and he was discharged on day 15 after admission. DISCUSSIONSThe mechanism of mesenteric injury in blunt abdominal trauma involves compression and deceleration forces which result in a spectrum of injuries that range from contusions, to tearing of the bowel wall, to shearing of the mesentery, to loss of vascular supply.3-5 Morbidity and mortality due to delayed diagnosis occur as a result of haemorrhage of injured mesenteric vessels and peritonitis from bowel wall rupture or bowel ischaemia. Patients with a slow oozing mesenteric haematoma may remain clinically undetected for days, until bowel necrosis occurs leading to peritonitis. Alternatively, a delayed haemorrhage may occur as a result of relaxation of vasospasm, pressure related displacement of thrombus, or liquefaction of temporary blood clot.The diagnosis of mesenteric injuries tends to be delayed. Early detection and surgical intervention, when necessary, are critic...

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“…The pathophysiology of the trauma can also be influenced by the type of motor vehicle and/or the type of security systems or restraints of the vehicle. The principles of the pathophysiology of these injuries were initially described by Motz [5] in 1890 and later by Vance [6] in 1923. Three mechanisms were categorized: (1) crushing force applied to the bowel against the spine; (2) shearing force of the bowel and mesentery along the lines of attachment; and (3) bursting force occurring secondary to increased intraluminal pressure.…”

Section: Discussionmentioning

confidence: 99%