Three Cases of Delayed Intestinal Obstruction After Blunt Abdominal Trauma

Abstract

We present three cases of delayed intestinal obstruction after blunt abdominal trauma, and review cases reported in Japan including our 3 cases. Two men and a woman, ages ranging from 28 to 89 years, were diagnosed with mesenteric injury based on CT scan findings. Despite apparent successful conservative observation, intestinal obstruction developed 3〜23 days after the accident in all three patients. All patients required a laparotomy due to intestinal stenosis, which was diagnosed with fluoroscopy using contrast medium through a long intestine tube or CT scan. In two patients, partial resection of the small intestine was performed. In the third patient case, a synechotomy on its own without any bowel resection was performed. Histopathological findings showed inflammatory cell infiltration of the subserosal layer and mesenterium, which led to cicatricial stenosis. These patients illustrate that delayed intestinal obstruction due to irreversible fibrosis formation and cicatrization can cause unsuccessful conservative therapies. Therefore, early surgery should be considered when a patient complains of ileus after any blunt abdominal trauma.