Delayed small bowel obstruction after blunt abdominal trauma. A case report

Abstract

We present a case of small bowel stricture and obstruction with delayed and subtle presentation 3 months after a car accident. Such a presentation is a rare clinical entity. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischaemic bowel stenosis may result from even small tears and contusions. These lesions may cause partial thickness ischaemia of the bowel wall, with mucosal ulceration and submucosal inflammation and fibrosis, or may cause full-thickness ischaemia with fibrosis of all layers. Mesenteric tears or intramural haematomas have been found on close inspection of the specimens. Our case supports the mesenteric injury theory since there is the initial CT-scan proof of retroperitoneal and consequently, mesenteric haematomas. Regardless of the pathophysiology of this clinical entity, it is very important that the condition of post-traumatic small bowel stricture should be suspected when a patient experiences bowel obstruction weeks, or even years, after sustaining abdominal injury, especially in connection with a seat-belt injury.