Small bowel obstruction due to traumatic mesenteric injury

Discussion:

Blunt abdominal trauma is a cause of post traumatic small bowel obstruction (PTSBO) 1. Typically, small bowel obstruction post trauma presents at least 2 weeks after the initial insult. It is thought that in this time, micro-perforations heal with fibrotic tissue, leading to stricture formation 2. It is unusual for a case of small bowel obstruction to present within only 2 days, as was the case with our patient.

Signs of small bowel obstruction in our case include:

  • dilated loops of small bowel
  • transition point from dilated small bowel to collapsed small bowel
  • stranding and distortion of the mesentery
  • poorly enhancing mucosa

The management for post-traumatic small bowel obstruction is controversial. Some reports have suggested that primary excision of the affected bowel with re-anastomosis has a good clinical outcome 3. On the other hand, there have also been small case studies where five out of six patients with PTSBO were successfully conservatively managed 4.

Case contributed by A/Prof. Pramit Phal.

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