Ileal Stenosis Occurred 3 Months after Blunt Abdominal Trauma

Abstract

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction. (Korean J Gastroenterol 2011;57:370-373)

A Rare Cause of Ileus: Late Jejunal Stricture following Blunt Abdominal Trauma

“…[4,7] Diagnostic criteria for the condition are as follows: a) previous history of blunt abdominal trauma, b) absence of described pathology before trauma, c) start of symptoms after trauma, d) radiological detection of intestinal stenosis, e) malignity or signs of specific inflammatory diseases seen in pathological evaluation of the resected portion. [1,2,7] Pathological confirmation is significant for cases in which no differential diagnosis can be reached through radiological evaluation, and for differentiating cases of Crohn's disease, intestinal tuberculosis, radiation enteritis, or cancer. [1,2,7,8] There has been increase in laparoscopic surgery as result of technological developments and accumulated experience with laparoscopic procedures.…”

“…[1,2,7] Pathological confirmation is significant for cases in which no differential diagnosis can be reached through radiological evaluation, and for differentiating cases of Crohn's disease, intestinal tuberculosis, radiation enteritis, or cancer. [1,2,7,8] There has been increase in laparoscopic surgery as result of technological developments and accumulated experience with laparoscopic procedures. Small intestinal obstruction related to adhesion occurs far less often in intra-abdominal laparoscopic procedure in comparison with open surgery.…”

“…There may be no symptoms that can be seen in the clinical condition of the patient in the early phase. [1,3] Small laceration, hematoma in the mesentery, or contusion and mural hematoma on the intestinal wall give way to localized ischemia. Inadequate mucosal feeding causes bacterial translocation, and ulcer formation and inflammation during tissue healing result in fibrosis and scarring.…”

“…[1,2] Jejunal stricture related to blunt abdominal trauma often form as result of minor trauma to the mesentery or the intestinal wall. There may be no symptoms that can be seen in the clinical condition of the patient in the early phase.…”

“…[1,2] It is often caused by fibrotic scar formation and blockage of passage entry during healing process of ischemic areas, which develop as result of localized damage to the intestinal wall or the mesentery. [1][2][3][4] A 37-year-old male patient, who had occupational accident 2 years prior, was surgically treated at our clinic after presenting with occasional abdominal pain and swelling that had been going on for a year. Presently described is rarely seen case of patient diagnosed with post-traumatic jejunal stricture.…”