Delayed colonic perforation in blunt abdominal trauma

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List members,
   
  I am intrigued by a recent case. 31 yo wf mvc, c/o only R hip pain. No abd pain or tenderness on exam. CT abd pelvis with IV contrast only positive for acetabular fracture. 4 days after trauma begins to conplain of abdominal pain. Gets pelvis fixed same day. 3 days later CT scan without contrast c/w ileus. 1 day later free air in abdomen. Intraoperatively find R colonice perforation with large deserosalized area.
   
  What is the differential on the etiology of the delayed perf.  Not alot of literature out there on this. Hematoma versus vascular injury?
   
  Thanks
   
  Rob Wagner, M.D.
  rwag63 at yahoo.com
  

 
  


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