Abstract
We report a man who developed delayed intestinal stenosis and fistulas of the colon and ileum after blunt abdominal trauma sustained during a vehicular collision. The fistulas were repaired by partial ileal resection and ascending partial colectomy. A man in his 80s was involved in a single-vehicle-collision owing to sudden onset of cerebral stroke. Findings on arrival comprised mesenteric injury, right 10th and 11th rib fractures, right hemothorax, and second cervical spinous process fracture. On the 7th day after injury, he complained of abdominal distention. Abdominal X-ray revealed gas in the small intestine; therefore we diagnosed ileus and placed a transnasal ileus tube. Gastrointestinal contrast examination performed on the 17th day after injury revealed fistulas in the colon and ileum. Therefore, partial ileal resection and ascending partial colectomy were performed on the 24th day after injury. It is difficult to diagnose delayed intestinal stenosis because the symptoms of intestinal obstruction are delayed and appear after improvement in the symptoms associated with blunt abdominal trauma. Delayed intestinal stenosis is irreversible and requires surgery. Regarding the mechanism of injury, our patient suffered mesenteric injury owing to abdominal pressure as the “submarine phenomenon” during the collision. Owing to circulatory disorder of the ileum, mucosal disorders and ulceration occurred, which were followed by irreversible cicatricial stenosis, adhesion, and penetration into the adjacent intestinal tract due to inflammation. The findings in this case might be valuable for physicians who examine patients involved in motor vehicle collisions for correct diagnosis and early intervention of delayed intestinal stenosis and fistula of the digestive tract.
