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Tue Apr 11 03:59:10 BST 2006

Rob,

I'd be surprised if the CT doesn't show more subtle signs of a possible bowel injury - thickened colon etc.  There are certainly
those cases where the mesentery is stripped from the bowel and early CT here would show little - but again I'd be surprised if it
showed nothing.  

Perhaps you could send me the CT (karim at trauma.org) and I'll post it to the website for review?

Karim

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of robert wagner
Sent: 10 April 2006 15:04
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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Delayed colonic perforation in blunt abdominal trauma