Delayed ileal perforation secondary to traumatic stricture presenting as pyrexia of unknown origin.
Traumatic small bowel strictures secondary to blunt abdominal trauma are extremely rare, with few cases reported. Delayed ileal perforation as a result of a traumatic ileal stricture remains, to the best of our knowledge, unreported. We herein report a case of a 28-year-old polytrauma patient admitted following a high speed road traffic accident who developed abdominal pain, distension and vomiting. Despite serial computerized tomography (CT) scanning, the diagnosis remained unclear until eight weeks into his admission by which time he had developed pyrexia. A fourth CT scan at this time revealed a collection in the right iliac fossa suggestive of possible appendicitis. Subsequent laparotomy, however, revealed an ileal stricture with upstream small bowel dilatation and perforation into a chronic abscess cavity. The appendix was normal. The patient underwent resection of the strictured segment and end ileostomy. Our case highlights the potential pitfalls in managing polytrauma patients who develop abdominal symptoms and in particular, traumatic small bowel strictures. We would like to highlight the limitations of CT in making this diagnosis and the importance of having a high index of clinical suspicion, particularly in the presence of distracting injuries.
Department of Surgery, Stoke Mandeville Hospital, Buckinghamshire, England. pd_how@hotmail.com
Peter David
PD
How
Hannah
H
Feddo
Eric
E
Woo
Andrew
A
Huang
D000007:Abdominal Injuries / Q000150:complications*; D000328:Adult; D003937:Diagnosis, Differential; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007082:Ileum / Q000293:injuries*; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*