Gangrene of the right colon: A rare complication of trauma-related systemic hypotension

Abstract

Correspondence to: Mr M. M. W. Parry, Department of Surgery, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa Hypotensive ischaemia of the colon has been described associated with non-abdominal trauma', congestive cardiac failure* and pancreatitis3. This usually causes merely mucosal damage and only ten cases of gangrenous colon associated with systemic hypotension from non-abdominal trauma have been reported in the English literature. Case reportA previously healthy 16-year-old boy sustained close-range low velocity gunshot wounds to his penis and right thigh. On admission 20 min after injury, he had no recordable blood pressure, and a tachycardia of 140/min. Following resuscitation with 4000 ml of crystalloid solution and 4 units of blood, a systolic blood pressure of 70mmHg was recorded 30 min after admission.Exploration of his thigh revealed injuries to the femoral vein and artery and extensive soft tissue damage. The femur was intact. There were no intra-abdominal injuries. The vessels were repaired and the penile wounds debrided. Intense venous congestion of the calf necessitated four compartment fasciotomy. Postoperatively, a foot pulse was readily palpable and the leg oedema rapidly resolved.The day after surgery, the patient complained of right iliac fossa pain. There was some local tenderness with diminished bowel sounds and a faecal occult blood test was negative. Abdominal X-ray and intravenous pyelogram were normal. His pain increased and by the third day he was pyrexial(38.8 "C) and had right abdominal rebound tenderness. He had not passed a stool and no blood was passed per rectum. A laparotomy was performed. This revealed gangrene (without perforation) of the caecum, ascending colon and proximal transverse colon, with pulsatile ileocolic and middle colic arteries. There was no other abdominal pathology. A right hemicolectomy with ileocolic anastomosis was performed and the patient made a good recovery. Histological examination of the resected specimen revealed full thickness bowel necrosis. None of the major arteries or veins contained thrombus but minor vessels contained microthrombi.

Delayed Presentations of Blunt Mesenteric and Intestinal Trauma in the Wake of Injury

“…Renton [18] was the first to report intestinal infarction after trauma in a previously healthy young patient. Parry et al [19] suggested that an anatomic abnormality of the mesenteric circulation might account for the right-sided necrosis. Early anatomic work done by Drummond [20], showed poor development of the marginal artery to the right colon in one-quarter of the specimens examined.…”

Case Report Ischemic Colitis Complicating Severe Acute Pancreatitis in a Child

“…Although it was not possible to determine the cause of ischemic colitis in this patient, it is speculated that a selective decrease in blood flow may have occurred in the region of the inferior mesenteric artery during hypovolemic shock soon after onset. Parry et al (10) reported a case of gangrene of the colon associated with systemic hypotension from nonabdominal trauma, and referred to 10 cases less than 30 years of age reported in the literature.…”