Abstract
A case of crush syndrome with multiple organ failure and massive intestinal necrosis is reported.
A 50-year-old female suffered severe crush injury to abdomen and both thighs in the 1995 Great Hanshin Earthquake, Japan. Her subsequent course was complicated by acute renal failure, disseminated intravascular coagulation, paralytic ileus, lung abscess and hepatic failure. She did not improved regardless of intensive treatment including blood purification, mechanical ventilation. Fasciotomy was not performed.
Paralytic ileus prolonged, but small bowel injury was not identified by CT scanning. Repeated physical examination didn't show absolute indications for surgery. Later intestinal necrosis was recognized by ultrasonography, and massive intestinal resection was performed on 28th hospital. day.
Postoperative course was good. Rehabilitation made her walked again. Conservative local treatment of crush injury bore the good outcome.
In a case of prolonged paralytic ileus after crush injury for abdomen, small bowel injury should be considered regardless of diagnostic tests.
