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Chirurgia 2000 August;13(4):235-8

language: Italian

Post-traumatic ischemic intestinal obstruction

Quaglino F., Coda A., Ferri F., Bossotti M., Manfredi S., Do D.


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Abdominal blunt traumas today are more and more frequent because car accidents and industrial injuries are increasing. Blunt abdominal trauma with mesenteric-intestinal damage often provoke lesions on the duodenum, on the first jejunal segment, and on the distal jejunal tract. Lesions about intermediate jejunal segments, characterised by a better motility and a better vascularization as well, are rare. Delayed intestinal obstruction is an infrequent consequence of blunt abdominal trauma; it may be the result of occult intraaddominal injury occurred during trauma, which becomes clinically obvious at variables times after the initial injury. The underlying mechanism may include intramural hemorrhage with fibroblastic reaction, and/or infiammatory response to bowel perforation; other mechanisms could be, like in the case proposed, unrecognised mesenteric lesions.
These lesions can lead frequently to stenosis of tracts of the small bowel, due to a progressive ischemic damage. The accompanying symptomatology, from 1 week to 18 months after trauma, is characterised by dyspepsia, abdominal pain, intermittent intestinal obstruction. Often, patients with blunt abdominal trauma are treated without laparotomy if signs of peritoneal irritation or hypovolemic shock are absent. If these patients, who were doing well on discharge from the hospital, return with signs and symptoms of incomplete small bowel obstruction, traumatic ischemic strictures of the intestine should be considered. The small bowel barium infusion will usually demonstrate the stricture and an early surgical intervention will rapidly return patients to a normal state. Arteriography is not essential for the diagnosis, but it could be useful to know the extension of intestinal stricture.

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