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Delayed colonic perforation in blunt abdominal trauma

Hardcastle Tim, Dr <tch at sun.ac.za> tch at sun.ac.za
Mon Apr 10 15:32:35 BST 2006


Rob

Not to my knowledge. The ileus picture may suggest inflammation in the abdomen, thus should rouse suspicion, but not diagnostic.

Tim

-----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 4:04 PM
To: Trauma &amp, Critical Care mailing list
Subject: RE: Delayed colonic perforation in blunt abdominal trauma


CT scan 1 day prior to perf with no oral or IV contrast demonstrates "severe generalized ileus"  Are there any CT findings that are found with a partial thickness injury and/or mesenteric hypoperfusion?

"Hardcastle Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> wrote:  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
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----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 &, 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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