A CASE OF NECROSIS OF THE SMALL INTESTINE DELAYINGLY CAUSED BY MESENTERIC INJURY AFTER A BLUNT ABDOMINAL TRAUMA

It sometimes happens that the small intestine is delayingly disturbed because of ischemia resulting from injuries of mesenteric vessels due to a blunt abdominal trauma. This time, we report a case of ileal necrosis due to a mesenteric injury diagnosed after an operation that was performed for peritoneal irritation after three days from a blunt abdominal trauma. A 51-year-old man was seen at our hospital because his car was crushed by his own traffic accident and his chest and abdomen hit hard the steering wheel. The laboratory data on admission showed increases in white blood cells and CRP, but otherwise normal, therefore intraperitoneal viscera were not suspected to be injuried. But, on the 3rd hospital day, his abdominal pain increased in intensity and the peritoneal irritation and the remarkable inflammatory findings on laboratory data appeared, therefore, we performed an operation under a preoperative diagnosis of peritonitis. There was the ileal full thickness necrosis 7 cm wide at oral portion in about 90cm from the ileum end. The border between necrotic portion and normal portion was well-defined, and the mesentery of necrotic gut was lacerated. But there was no perforation of the small intestine, and an ileectomy was carried out. It was suggested that the delayed small intestinal necrosis was caused by the ischemia resulting from the injury of mesenteric vessels due to the blunt abdominal trauma.