A Case of Delayed Ischemic Stenosis of the Ileum due to a Blunt Abdominal Trauma

Hisato Higashi, Takashi Yamamoto, Jun-ichiro Tanaka, Atsuko Ohki, Kanako Ban, Seiichi Yamagata, Kozo Masuda, Haruhiko Shida, Tomohiro Imanari and Takehisa Machida

Department of Surgery, Tokyo Kosei Nenkin Hospital

We present a case of posttraumatic ischemic stenosis of the ileum. A previously healthy 26-year-old man suffered lower abdomen trauma after being hit by a truck and a forklift. His abdominal pain disappeared immediately, but 13 days after the accident, he was admitted to the other hospital for abdominal pain and vomiting. Abdominal radiograph showed an intestinal obstruction and he was treated conservatively, but experienced no relief and exacerbation of these symptoms. He was referred to our hospital 21 days after the accident. Abdominal computed tomography showed stenosis of the ileum and mesenteric thickening. During a laparotomy the same day, stenosis of the ileum and mesenteric fat necrosis at 20cm oral from the ileo-colic junction were found. About 10cm of the ileum including the lesion was resected, and the 2 ends of the ileum were anastomosed. The postoperative course was uneventful, and he was dicharged on postoperative day 13. Pathologically, he found a fibrin-thrombosed obstructed ileal artery and ischemic intestinal stenosis. The stenosis was considered to be organic irreversible change caused by a circulatory disorder of the intestinal duct due to mesenteric injury. Small bowel stricture after blunt abdominal trauma is rare in bowel obstruction. Abdominal CT was useful in detecting this. Since intestinal injury due to blunt abdominal trauma can cause delayed intestinal stenosis, carefull observation of the clinical course and early surgery are important.

Key words
blunt abdominal trauma, delayed ischemic small bowel stenosis, bowel obstruction

Reprint requests
Hisato Higashi Department of Surgery, Tokyo Kosei Nenkin Hospital 5-1 Tsukudocho, Shinjuku-ku, Tokyo, 162-8543 JAPAN

Accepted
May 1, 2002

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