A Case of Late-Onset Intestinal Stenosis Associated With Perforated Peritonitis Following Blunt Abdominal Trauma Treated by Laparoscopic-Assisted Surgery

Abstract

A 9-year-old girl was run over by a truck and brought to a previous hospital. An external skeletal fixation was performed for her pelvic fracture. Although oral intake started postinjury day 5, she had been suffering from repeated intestinal obstruction since then. At 6 weeks after the injury, she was referred to our hospital because she had fever in addition to intestinal obstruction symptoms. An urgent enhanced computed tomography scan revealed a dilated intestine and pelvic abscess. She underwent laparoscopic-assisted surgery with minilaparotomy. Before the laparoscopic procedure, intestinal decompression was performed by handling the intestine through the wound at the umbilicus. Then, we found a mesenteric defect with severe stenosis of the ileum. The affected bowel segment was resected, and primary anastomosis was performed. The patient was transferred to the previous hospital 13 days later with normal bowel function for further treatment of her pelvic fracture. Although posttraumatic intestinal stenosis is a rare condition and difficult to diagnose, laparoscopic-assisted surgery could be feasible and useful for the diagnosis and treatment of intestinal obstruction even with a dilated intestine and peritonitis.