Presentation
The patient presented with generalised abdominal pain and fevers following a motor vehicle crash. There was bruising across the lower abdomen.
Patient Data
![](https://prod-images-static.radiopaedia.org/images/66248160/937e26760753225d32f579950b189d3f9d41e0b8e6a0ec27d0453c949083580c_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/66247811/2babadc7796b7ec6dbd78490dfa0e7c199bbb99bc09ca5d43e4ef4c72d7827a6_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/66248160/937e26760753225d32f579950b189d3f9d41e0b8e6a0ec27d0453c949083580c_big_gallery.jpeg)
There is moderate volume pneumoperitoneum with multiple locules of free gas throughout the abdomen. There is diffuse thickening of the small and large bowel with surrounding fat stranding - particularly of the sigmoid colon. Thickening of the peritoneum in keeping with diffuse peritonitis.
There is a perforation of the sigmoid colon with extra-luminal faecal material. There are also multiple pockets of rim-enhancing free fluid throughout the abdomen including a collection within the rectovesical pouch.
Case Discussion
The CT images demonstrate a traumatic sigmoid perforation and sigmoid mesenteric tear secondary to rapid deceleration from a motor vehicle crash.
The clinical history of a high velocity motor vehicle crash with a seat-belt marking is concerning for rapid deceleration injuries to abdominal visceral organs 1. The rapid deceleration can cause large sheering forces between the fixed and mobile components of the intra-abdominal organs 2.
This patient proceeded to have a laparotomy with findings of four quadrant faeculent contamination, a large perforation within the sigmoid colon measuring 6 x 8 cm and an associated bucket handle injury of the mesentery.