Abstract
IntroductionAbdominal trauma is a source of significant mortality and morbidity. Bowel injury as a result of blunt abdominal trauma is usually evident within hours or days of the accident.Case presentationA 38-year-old Caucasian Greek man presented with a subtle and delayed small bowel obstruction caused by a post-traumatic ileosigmoid fistula and ileal stricture four months after a road traffic accident.ConclusionDelayed occurrence of post-traumatic small bowel stricture and ileosigmoid fistula is an uncommon surgical emergency. General surgeons as well as emergency physicians should bear this manifestation in mind should a patient return to the hospital several weeks or even years after blunt abdominal trauma with symptoms or signs of bowel obstruction.
Highlights
Abdominal trauma is a source of significant mortality and morbidity
We present a case of ileal stricture and an ileosigmoid fistula as a result of blunt abdominal trauma (BAT)
Traumatic small bowel stricture and delayed small bowel obstruction secondary to BAT is a rare clinical entity. It is the result of local ischemia of the bowel wall and its subsequent healing with fibrosis and stricture, which causes the delayed onset of symptoms [12]. This local bowel ischemia can be caused by an injury to the mesentery, which impairs the blood supply to the bowel resulting in a stenotic segment, or a trauma which causes sufficient damage to the small bowel to result in hemorrhagic mucosal infarction or subclinical bowel perforation [8,9,12,13]
Summary
Patients with BAT who have small amounts of intraperitoneal fluid as the only finding on CT and are hemodynamically stable can be safely managed without surgical intervention. Diagnosis of post-traumatic small bowel stricture could be difficult but general surgeons and emergency physicians should bear in mind this clinical manifestation and remain vigilant, especially when a patient presents with free intraperitoneal fluid after BAT on imaging, even if there are no signs of solid organ injury. Author details 1General Surgery Department, General Hospital of Larissa, Greece. Authors’ contributions BK performed the literature search and was the chief author in writing the manuscript. DK performed the literature research and co-authored the paper. KS was the attending surgeon of the case and checked the paper. SG assisted with the linguistics and performed the literature research. GA was the chief surgeon and performed the final check of the paper. Competing interests The authors declare that they have no competing interests
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