![]() His initial vital signs were notable for a blood pressure of 122/72 mm Hg, a heart rate of 122 beats/ min and a respiratory rate of 22 breaths/ min. The patient was the restrained vehicle driver and the Emergency Medicine Services found him at the scene soon after a collision with a bus. We report a case of an isolated traumatic injury of the cecum and ascending colon along with mesocolon injury after a motor vehicle accident.Ī 31-year-old man with no previous medical history was transported to the Emergency Department (ED) by ambulance on a spine board and with a cervical collar in place after a car accident. Isolated colon injury following BAT is a rarely encountered condition since colon injury is usually accompanied by other intra-abdominal organ injuries. Signs and symptoms often require a number of hours before clinical apparent peritonitis appears. Diagnosis of bowel injury is associated with unacceptable diagnostic delays and is a difficult task in patients suffering from BAT. Early recognition is of superior importance because of the significant morbidity and mortality of this type of injuries. The pathogenic mechanisms of HVI injury after BAT are substantially two, acting isolated or combined compression forces and deceleration forces. Significant mesenteric injuries include disruption of the mesentery, a mesenteric injury resulting in ischemic bowel, and active mesenteric bleeding. Bowel injuries that warrant surgical attention include full-thickness perforation, a seromuscular tear, and devascularized bowel. ![]() Mesenteric injuries may be isolated or accompanied by associated HVI. HVI are defined as a spectrum of bowel injury ranging from hematomas to full thickness defects in the walls of the stomach, small and large bowel. The most common site of injury to the intestine in BAT is the small bowel followed by colon with mesenteric injuries occurring three times more commonly than bowel injuries. HVI are not common and occur in approximately 1 % of all blunt trauma patients. Given the potential for devastating outcomes, prompt diagnosis and treatment is necessary and high clinical suspicion is required. Although CT has become the main diagnostic tool for this type of injuries, there are few pathognomonic signs of colon injury on CT. Diagnostic peritoneal lavage, ultrasound, CT and diagnostic laparoscopy are used to evaluate BAT. However, the accuracy of these findings remains low. Abdominal ‘seatbelt’ sign, ecchymosis of the abdominal wall, increasing abdominal pain and distension are all associated with HVI. Isolated colon injury is a rare finding after blunt trauma and usually accompanied by other intra-abdominal organ injuries. Identifying an isolated traumatic injury to the bowel or mesentery after BAT can be a clinical challenge because of its subtle and nonspecific clinical findings meeting that challenge may eventually lead to a delay in diagnosis and treatment with subsequent increase in associated morbidity and mortality. Patient’s recovery progressed uneventfully. A right hemicolectomy along with primary ileocolonic anastomosis was performed. Hematoma of the adjacent mesocolon expanding to the root of mesenteric vessels was also noted. An exploratory laparotomy was performed, hemoperitomeum was evacuated, and a subserosal hematoma of the cecum and ascending colon with areas of totally disrupted serosal wall was found. A computed tomography scan (CT) that followed showed a hematoma of the mesocolon of the ascending colon with active extravasation of intravenous contrast material. After initial resuscitation, focused assessment with sonography for trauma examination (FAST) was performed revealing a subhepatic mass, suspicious for intraperitoneal hematoma. This is a case of a 31-year-old man, admitted to the emergency department after being the restrained driver, involved in a car accident. Clinical assessment alone in patients with suspected intestinal or mesenteric injury after blunt trauma is associated with unacceptable diagnostic delays. Isolated colon injury is a rarely encountered condition. The most common site of injury to the intestine in blunt abdominal trauma (BAT) is the small bowel followed by colon, with mesenteric injuries occurring three times more commonly than bowel injuries. The reported incidence of hollow viscus injuries (HVI) in blunt trauma patients is approximately 1 %.
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