Perforation of the transverse colon as a result of minor blunt abdominal trauma

Abstract

A previously fit 20-year-old man fell on to the kerb at the roadside, landing on the left side of his abdomen. He was taken to the local casualty department. No serious intraabdominal injury was suspected and the patient was discharged home with oral analgesia. After his discharge from the casualty department, he became constipated and suffered from occasional vomiting, was anorexic and continued to have left upper abdominal pain. One week after the accident, he opened his bowels for the first time and passed 500 ml of dark red blood PR, he was then admitted to hospital. On admission, he looked unwell, was pyrexial and demonstrated signs of dehydration. His cardiovascular system was stable with a pulse of 90 and a blood pressure of 110/60. On inspection of his abdomen there was no evidence of any external injuries. Palpation revealed a soft abdomen with some mild tenderness in the left upper quadrant but no evidence of peritonitis. Bowel sounds were normal. Rectal examination and rigid sigxnoidoscopy confirmed the presence of dark red blood mixed in with loose motions. Blood investigations revealed a haemoglobin of 10.2 fl, suggesting moderate blood loss, and a white cell count of 26 x 10’. All other blood tests were normal. An erect chest X-ray showed no thoracic abnormality and no air under the diaphragm. A plain supine abdominal film revealed a large air-filled shadow separate from the stomach in the left upper abdominal quadrant (Figure 1). A CT scan of the abdomen was obtained, which confirmed this to be free air in the lesser sac (Figure2). No other abnormalities were noted. Laparotomy revealed a retroperitoneal haematoma and an extensive inflammatory mass involving the transverse colon which had perforated into the lesser sac. There was no evidence of ischaemia of the bowel. The involved area of colon was resected and a primary anastomosis performed. The patient was discharged on day 9 having suffered no post operative complications.