Posttraumatic intestinal stenosis: radiographic and sonographic appearance

Loberant, Norman; Szvalb, Sergio; Herskovits, Miriam; Cohen, Isaac; Salamon, Vera

doi:10.1007/s003300050196

Cited by 13 publications

(9 citation statements)

References 6 publications

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“…Authors agree that feeding deficiency related to damaged mesentery is primary reason for stricture formation. [4][5][6] In the present case, macroscopic evaluation showed fibrotic thickening in the mesentery of the strictured segment. It was suggested that the damage to the mesentery was the principal reason for the patient's condition as pathological analysis revealed focal ulcerated area and active chronic nonspecific inflammation in the area.…”

Section: Discussionsupporting

confidence: 54%

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

Aday

Gündeş²,

Değer³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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Small intestinal stricture forming in the late phase following nonpenetrating abdominal trauma is rare cause of ileus. It has often been suggested that it is result of localized feeding deficiency on the intestinal wall related to minor trauma in the mesentery. Laparoscopy has been increasingly used for diagnosis and treatment. Diagnosis should be supported by pathological analyses in case of intestinal stenosis related to blunt abdominal traumas.

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Section: Discussionsupporting

confidence: 54%

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

Aday

Gündeş²,

Değer³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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“…5 CT showed concentric thickened intestinal wall of various lengths and the expansion of the proximal bowel and the decrease of the inner diameter of the distal bowel. 6 Barium series showed various narrowed concentric inner diameters of the bowel and ulcers in the mucous layer.…”

Section: Case Reportmentioning

confidence: 99%

Ileal Stenosis Occurred 3 Months after Blunt Abdominal Trauma

Kang

Jeon

Seo

et al. 2011

Korean J Gastroenterol

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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)

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“…9 It is more likely, however, for focal ischaemia of the gut to be secondary to a mesenteric insult rather than direct ischaemia of the bowel wall. 10 It is the authors' view that it is far more likely for the vasculature of the mesentery to be injured by external forces as this structure is fixed retroperitonealy and is less elastic than bowel wall. Bowel is a hollow viscus and hence deforming forces are more likely to be dampened and dissipated.…”

Section: Discussionmentioning

confidence: 99%

Late small bowel obstruction after blunt abdominal trauma

Maharaj¹,

Perry²,

Ramdass³

et al. 2003

Postgraduate Medical Journal

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Blunt abdominal trauma with intraperitoneal injury usually presents acutely. On rare occasions, such patients can present later on with features of small bowel obstruction due to stricture formation. It is thought that such a delayed stricture is due to subclinical bowel perforation, localised gut ischaemia, or injury to the mesenteric vasculature. This case demonstrates the mesenteric vascular injury theory to be the cause of the bowel stricture. B lunt abdominal trauma producing intraperitoneal injury usually presents acutely, necessitating laparotomy for intestinal perforation or mesenteric vascular injury.1 In the absence of shock and peritonism, patients with blunt abdominal injury may be treated conservatively. On rare occasions, such patients can present later on with features of small bowel obstruction.2 3 Delays in presentation between the initial insult to the abdomen and the obstructive episode have been documented to be as long as 26 years in the European literature. 4The exact pathophysiology is unclear, with three possible causes cited-subclinical small bowel perforation, localised bowel ischaemia, and mesenteric vascular injury. 5 We report the case of a 22 year old man who presented with small bowel obstruction two years after blunt abdominal trauma. Laparotomy revealed distal ileal stenosis with vascular mesenteric injury. This case reinforces the mesenteric vascular injury theory as the cause of the bowel stricture. CASE REPORTA healthy 20 year old man presented to the General Hospital, Port-of-Spain, having been involved in a motor vehicle accident one hour beforehand. He was the driver of a car that smashed into the rear of a stationary vehicle at low velocity. He was wearing a lap and shoulder belt at the time.Though he sustained blunt abdominal injury, bruising or the seatbelt sign were not evident. He was found to be stable with minimal abdominal tenderness. He was observed for a 24 hour period and subsequently discharged.He was seen repeatedly in the outpatient clinic for vague colicky abdominal pains which he had not experienced before injury. No investigations were ordered. Two years after the initial injury he presented to the surgical service with vomiting and constipation. His abdomen was mildly tender and grossly distended with increased bowel sounds. Plain abdominal radiographs revealed small bowel distension involving the jejunum and ileum.A laparotomy was performed and a stricture of the terminal ileum was observed. The adjacent mesentery was scarred and the mesenteric arterial pulsations were impalpable (fig 1). On table Doppler assessment revealed reduced biphasic arterial impulses within this segment of mesentery.The stenosed segment of ileum was resected and an end to end anastomosis performed. The specimen was examined histologically, revealing mucosal ulceration of the gut and degenerative infiltration of the mesenteric vessels.The patient was discharged after an uneventful postoperative course, and has remained symptom-free after five years.

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Posttraumatic intestinal stenosis: radiographic and sonographic appearance

Cited by 13 publications

References 6 publications

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

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

Ileal Stenosis Occurred 3 Months after Blunt Abdominal Trauma

Late small bowel obstruction after blunt abdominal trauma

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