Delayed colonic perforation in blunt abdominal trauma

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Rob

Initial injury was most likely partial thickness injury to colon (bruise) which may have associated mesenteric hypoperfusion (was there a mesenteric tear?). Over next 4-5 days undergoes full thickness necrosis and perforated. Not likely to be a vascular injury pre-se.

Have seen this more often with small bowel than colon though.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
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Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of robert wagner
Sent: Monday, April 10, 2006 3:23 PM
To: Trauma &amp, Critical Care mailing list
Subject: Delayed colonic perforation in blunt abdominal trauma


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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