Mechanical small bowel obstruction following a blunt abdominal trauma: A case report

Delayed traumatic small bowel obstruction diagnosed by point-of-care ultrasound (POCUS)

Delayed small bowel obstruction is a rare complication of blunt abdominal trauma and is typically diagnosed by computed tomography (CT) imaging. A 22-year-old man initially presented to Emergency Department 12 h after a motor vehicle collision and CT imaging was unrevealing for any intra-abdominal injury. The patient returned 4 days later with new abdominal pain, vomiting, and watery stool. His exam demonstrated only suprapubic tenderness without guarding. A point-of-care ultrasound was performed by the emergency physician given recent abdominal trauma which showed dilated loop of small bowel with a "to-and-fro" sign raising the concern for small bowel obstruction. A repeat CT scan of the abdomen/pelvis confirmed the presence of small bowel obstruction with a transition point at the distal ileum caused by focal mesenteric edema. This case highlights a rare complication of blunt abdominal trauma that emergency physicians should consider in their differential diagnosis and not be misled by recent negative imaging. Additionally, the case illustrates the role of POCUS in evaluating not only intra-abdominal free fluid but also alternative traumatic abdominal pathology.

Case Report: Delayed Presentation of Bowel Obstruction Caused by Blunt Abdominal Trauma

Introduction

Bowel obstruction is a rare but well reported complication of blunt abdominal trauma (BAT). Obstruction is most often seen acutely caused by bowel wall hematomas and chronically as a result of post-traumatic strictures. Here, we present a novel case of BAT causing a subacute obstructing bowel wall hematoma.

Case Report

A healthy, 32-year-old male presented to our emergency department with three days of nausea and vomiting. Chart review revealed he had been seen two weeks prior after a high-speed motor vehicle collision. During that initial visit, the patient had a benign abdominal exam and was discharged without imaging. On this return visit, the patient was found to have a large, obstructing colonic hematoma.

Conclusion

Because emergency physicians care for patients in both the acute and subacute phases of trauma, clinicians should recognize the more subtle sequelae of BAT.

Idiopathic congenital anomalous bands: About ten cases with systematic review of the literature

Background and Objectives: Purpose

There are various causes and associated conditions in anomalous bands. Idiopathic congenital anomalous bands are extremely rare. The use of the term “congenital bands” may, in reality, not describe the same situation. The study aims to report our series of idiopathic anomalous bands and proposes an accurate and consistent classification of anomalous bands in order to clarify the origin of each band.

Methods

This study, conducted from January 2005 to January 2018, included all patients admitted to the emergency departments with a clinical diagnosis of intestinal obstruction resulting from bands that have no identifiable embryological or acquired basis called “idiopathic”. Recorded operative findings included the site of obstruction and the operative procedure to relieve it.

Results

The sample consists of seven boys and three girls with age range from one day to 9 years with symptoms and signs indicative of intestinal obstruction. Surgical intervention was performed, and intraoperative findings revealed a thick and vascularized idiopathic band, in different locations, which was responsible for intestinal obstruction in all patients. Clinical courses were uneventful in eight cases.

Conclusion

Idiopathic anomalous congenital bands causing intestinal obstruction are not frequently encountered in surgical practice and these bands are often difficult to classify and define. We believe that our new classification is a practical communication tool for medical professionals to summarize and clarify the different types of anomalous bands.