Abstract
An 80-year-old woman receiving anticoagulant therapy was seen at our hospital because of abdominal pain 10 days after she had fallen down during walking. A series of detailed examinations showed accumulation of bloody ascites and a tumor-like mass of the colon at the splenic flexure, which was suggestive of an intramural hematoma of the colon. The patient's general condition was improved by conservative treatment, and abdominal symptoms soon subsided. However, severe abdominal pain suddenly developed 16 days after the episode of the trauma, and therefore enhanced computed tomography was immediately performed, leading to the diagnosis of perforation of the digestive tract. An emergency surgery demonstrated that the perforated site was located at the splenic flexure and surrounded with resolving intramural hematoma of the colon ; therefore, segmental colon resection and colostomy were chosen as the operative strategy. The histopathological findings showed formation of granulation tissue replacing rupture of the muscular layer, and relatively-chronic ischemic changes of the colon wall. Until now, only four cases of delayed colon perforation after an abdominal blunt trauma have been reported in the Japanese literature. In all reported cases, ischemic changes of the colon wall secondary to the blunt injury might be associated with the cause for delayed perforation. Likewise, in our case, the same underlying mechanism might be deeply involved in delayed perforation, but in particular, bleeding tendency associated with anticoagulant therapy might aggravate acute colonic intramural hematoma due to the blunt abdominal trauma, resulting in worsening of ischemic changes of the colon wall, followed by perforation of a fragile site.
