A CASE OF POST BLUNT ABDOMINAL TRAUMATIC DELAYED STENOSIS OF THE SMALL INTESTINE

The very rare complication of small intestinal injury due to blunt abdominal trauma involves delayed stenosis of the small intestine. In the present study, our experience of a case of blunt abdominal trauma which could be preoperatively diagnosed was totalized together with eight cases reported in Japan during the past 20 years and is reported in the light of the related literarure. The patient, a 21-year-old man, visited our hospital with chief complaints of abdominal pain and vomiting 17 days after blunt abdominal trauma. Delayed stenosis of the small intestine due to the trauma was diagnosed after scrupulous examination, and the patient underwent surgery. As the stenosis was situated in the jejunum on the anal side 1.9m distant from Treitz's ligament, and the mesentery around the stenosis cicatrized, enterectomy was performed. Histopathological findings showed small intestinal ulcer. The cause of the stenosis was considered to be organic change caused by a circulatory disorder of the intestinal duct due to the mesenteric injury. In our case, a long intestinal tube (Dennis tube) was inserted, leading not only to improvement of ileus symptoms but also to useful determination of the site and the degree of stenosis. With regard to the eight cases of this disease previously reported in Japan, all were in male subjects, with an age range of 4-60 years. The time elapsed from the trauma to the appearance of symptoms was 4-30 days, or 16 days on average. Each small intestinal stenosis was diagnosed by small intestinal radiography, angiography, laparoscopy and so on, used for preoperative diagnosis. As to the stenotic site in the small intestine, no definite tendency was found.