Unusual cause of recurrent small bowel obstruction in an incarcerated patient: ingested plastic foreign bodies

Abstract

patient demonstrates a unique case in which small bowel obstruction is secondary to extrinsic compression from a mesenteric haematoma, rather than progressive ischaemia secondary to a vascular injury leading to luminal stricturing.In our review of the English literature, all cases of delayed small bowel obstruction following blunt abdominal trauma have been managed operatively. [1][2][3][4][5][6][7] Operative management is clearly indicated in patients who are haemodynamically unstable or demonstrate evidence of an acute abdomen; however, there is an argument to proceed with non-operative management in stable patients. The decision to manage these patients conservatively poses a difficult clinical scenario, particularly when obstruction can occur months following the initial blunt injury. 5 Whilst we should have a high clinical suspicion for the possibility of stricture formation following mesenteric injury, which is unlikely to resolve non-operatively, it is important to manage patients according to their clinical and radiological findings. In a setting where obstruction is secondary to extrinsic compression rather than stricturing, it can be inferred that this obstruction will be relieved as the haematoma liquefies. We propose that in patients with extrinsic small bowel compression leading to obstruction, the reduced morbidity of pursuing nonoperative management is a viable option.This case demonstrates a unique presentation of small bowel obstruction secondary to extrinsic compression by a mesenteric haematoma. Despite literature indicating that patients with small bowel obstruction secondary to blunt abdominal trauma often require operative management, we highlight a patient in which conservative management with decompression resulted in a successful outcome.