2025 Volume 45 Issue 3 Pages 386-389
A 19-year-old man who sustained injuries while riding in the passenger seat of a light motor vehicle that collided head-on with another car was brought to our hospital by ambulance. He complained of abdominal pain, and contrast-enhanced computed tomography (CT) showed severe edema of the jejunal wall and surrounding fluid retention, but no free air in the abdominal cavity. Since the abdominal symptoms failed to improve by 8 hours after the injury and a follow-up CT showed increased fluid retention around the intestines, we performed emergency surgery. The jejunum was perforated approximately 20 cm from the ligament of Treitz, and partial jejunectomy was performed. On postoperative day 1 (approximately 36 hours after the injury), the patient complained again of abdominal pain. When the abdomen was re-opened, enlargement of the mesenteric hematoma, extensive congestion of the ascending and sigmoid colons, and partial mesenteric ischemia were observed. Therefore, we performed right hemicolectomy, partial sigmoid colectomy, and diverting ileostomy. The patient’s subsequent course was uneventful, and he was discharged ambulatory on day 26. As no previous cases of delayed ischemic necrosis of the colon at multiple sites due to a mesenteric hematoma have been reported, we are reporting this case along with a review of the literature.
