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Thu Feb 2 13:23:42 GMT 2006

Tim,
I am fairly convinced that this was a direct shot from the handlebar of
the snowmobile to this fellows LLQ, and that the sigmoid was nailed
between the anterior abdominal wall and the pelvic brim, over which the
diseased/perforated sigmoid was found.  Probably had a transmural
hematoma and perhaps even the scenario that Karim showed to us in his
photo, of the almost through and through disruption, with only mucosal
integrety, followed by death due to vascular supply deprivation.
Cheers,
Ron

>>> tch at sun.ac.za 02/02 12:06 AM >>>
Ron

Interesting - I have seen many colons contused after blunt trauma, but
never perforate, unless there is an underlying distal obstruction
present or otherwise there may be a vascular injury. (i.e. the older
trauma patient with other pathology.) We see many more blunt injured
small bowel (30-40 per year), of whom some present as delayed
perforation, usually after a segment of bowel is devascularised, dies
and perforated around day 5.

Most of these patients are referred from "St Elsewhere"

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 (U.S.)
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

2 Lorient Close
Vredekloof, Brackenfell
7560, Western Cape,
South Africa
e-mail: tch at sun.ac.za 
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302
Home: +27219813098
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