Delayed Presentation of an Isolated Sigmoid Colon Injury Following Blunt Abdominal Trauma: A Case Report & Review of Literature

Abstract

Introduction: Most colonic injuries are due to penetrating abdominal trauma. Colon injury rarely occurs after blunt abdominal trauma. Colonic trauma is usually associated with other intra-abdominal and extra-abdominal injuries. The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation: a 25-years-old man who present after seven days of blunt abdominal trauma with clinical evidence of peritonitis, on laparotomy isolated sigmoid colon perforation was found which was managed with end colostomy. Conclusion: Isolated colon injury after blunt abdominal trauma is rare and difficult to diagnose. Delay in diagnosis increases the morbidity and mortality rates. Therefore it is important for the trauma surgeon to keep high index of suspicion colonic perforation, to facilitate its timely diagnosis and management.

A Case of Delayed Cecal Perforation After Abdominal (Seat Belt) Injury

“…Isolated blunt trauma colonic injuries are rare [4,11]. We recommend a combination of serial abdominal exams, x-ray, ultrasound, and computed tomography scans as indicated for diagnostic workup [7][8][9].…”

“…Rapid deceleration can result in shearing between the mobile regions of the colon and the natural fixed points at the sigmoid and ileocecal regions, causing sigmoid and ascending colon injury [7,8]. Colonic burst injuries can also occur secondary to mechanical occlusion during blunt trauma when intraluminal pressure exceeds the colonic wall's tensile strength [8,9]. Common blunt trauma colon injury patterns include serosal tears, contusions, laceration, transection, mesenteric tear, and hematoma [9,10].…”

“…Colonic burst injuries can also occur secondary to mechanical occlusion during blunt trauma when intraluminal pressure exceeds the colonic wall's tensile strength [8,9]. Common blunt trauma colon injury patterns include serosal tears, contusions, laceration, transection, mesenteric tear, and hematoma [9,10]. Colonic devitalization secondary to devascularization causes delayed colonic perforation [8].…”

“…The absence of clear signs like peritonitis and pneumoperitoneum does not rule out blunt trauma colon injury, so we recommend a high index of suspicion [8,9]. To intervene in blunt trauma abdominal injuries, surgeons perform exploratory laparotomies [12].…”

“…Our patient presented with neurologic injury and thus was not hemodynamically stable on presentation and may have benefitted from an initial exploratory laparotomy. Primary closure, resection with anastomosis, or colostomy are treatment options depending on the size of the colonic injury, gross contamination, and signs of ischemia or bowel necrosis [7][8][9]. The repair of serosal tears, when encountered especially with no signs of further devastation or mesenteric injury, has been questioned in the literature [15].…”