Perforation sigmoid with bucket-handle mesenteric tear from trauma

Case contributed by Lilian To
Diagnosis certain

Presentation

The patient presented with generalised abdominal pain and fevers following a motor vehicle crash. There was bruising across the lower abdomen.

Patient Data

Age: 25 years
Gender: Male
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Axial C+ portal
venous phase
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Info

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.

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