2018 Volume 38 Issue 6 Pages 997-1000
A 42-year-old man suffered injuries when assaulted by an acquaintance during an argument, but returned home without any complaint immediately thereafter. Abdominal pain/vomiting presented the next day, and upon visiting a nearby clinic intra-abdominal bleeding was detected via CT scan. He was transferred to our hospital 18 hours post-accident. At the time of arrival, radial arterial blood pressure was unmeasurable. An abdominal plane CT scan showed fluid collection and a massive hematoma in the transverse mesocolon and lateral side of the duodenum. One and a half hours after arrival, emergency laparotomy was performed for intra-abdominal bleeding. Fresh bleeding was found in the peritoneal cavity, so we opened the lesser omentum and applied pressure to the abdominal aorta. A laceration 10×15 cm in the transverse mesocolon and active hemorrhaging from the middle colic artery/vein were identified, and hemostasis was performed. No injury of other intra-abdominal organs was confirmed. The final diagnosis was traumatic transverse mesocolon (type Ⅱb) and middle colic arteriovenous injury. The postoperative course was uneventful and he was discharged 12 days after surgery. Three months post-injury, the patient is fully functional with no complications. This is a report of a case of late-onset shock caused by middle colic arteriovenous injury from blunt abdominal trauma.
