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Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report
INTRODUCTION: In blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. PRESENTATION OF CASE: The authors present the case of a 68 years old male, admitted to...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336400/ https://www.ncbi.nlm.nih.gov/pubmed/25576959 http://dx.doi.org/10.1016/j.ijscr.2014.12.029 |
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author | Pimenta de Castro, J. Gomes, G. Mateus, N. Escrevente, R. Pereira, L. Jácome, P. |
author_facet | Pimenta de Castro, J. Gomes, G. Mateus, N. Escrevente, R. Pereira, L. Jácome, P. |
author_sort | Pimenta de Castro, J. |
collection | PubMed |
description | INTRODUCTION: In blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. PRESENTATION OF CASE: The authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300 kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon bleeding. An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent hematoma of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the hematoma was identified, justified an additional enterectomy, after what the patients recovery progressed uneventfully. DISCUSSION: In this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric hematoma, or, in spite of that, a state of low perfusion could have lead to total wall ischemia of an already irrigation compromised segment. Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and mesenteric injuries are potentially missed due to decreased exploratory laparotomies for blunt abdominal trauma. CONCLUSION: Although uncommon, small bowel and mesenteric injuries are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis |
format | Online Article Text |
id | pubmed-4336400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-43364002015-03-03 Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report Pimenta de Castro, J. Gomes, G. Mateus, N. Escrevente, R. Pereira, L. Jácome, P. Int J Surg Case Rep Case Report INTRODUCTION: In blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. PRESENTATION OF CASE: The authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300 kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon bleeding. An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent hematoma of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the hematoma was identified, justified an additional enterectomy, after what the patients recovery progressed uneventfully. DISCUSSION: In this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric hematoma, or, in spite of that, a state of low perfusion could have lead to total wall ischemia of an already irrigation compromised segment. Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and mesenteric injuries are potentially missed due to decreased exploratory laparotomies for blunt abdominal trauma. CONCLUSION: Although uncommon, small bowel and mesenteric injuries are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis Elsevier 2014-12-24 /pmc/articles/PMC4336400/ /pubmed/25576959 http://dx.doi.org/10.1016/j.ijscr.2014.12.029 Text en © 2014 The Authors http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/). |
spellingShingle | Case Report Pimenta de Castro, J. Gomes, G. Mateus, N. Escrevente, R. Pereira, L. Jácome, P. Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title_full | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title_fullStr | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title_full_unstemmed | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title_short | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report |
title_sort | small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336400/ https://www.ncbi.nlm.nih.gov/pubmed/25576959 http://dx.doi.org/10.1016/j.ijscr.2014.12.029 |
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