title: Stress-induced intestinal necrosis resulting from severe trauma of an earthquake.
abstract: OBJECTIVE
  To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.
  
  
  METHODS
  Three patients in our study were trapped inside collapsed structures for 22, 21 and 37 h, respectively. The patients underwent 3-4 operations after sustaining their injuries. Mechanical ventilation, intermittent hemodialysis and other treatments were also provided. The patients showed signs of peritoneal irritation on postoperative days 10-38. Small intestinal necrosis was confirmed by emergency laparotomy, and for each patient, part of the small bowel was removed.
  
  
  RESULTS
  Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively. The third patient who performed 4 operations was discharged and made a full recovery. Three patients had the following common characteristics: (1) Multiple severe trauma events with no direct penetrating gastrointestinal injury; (2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment; (3) Progressive abdominal pain and tenderness, and peritoneal irritation was present on post-traumatic days 10-38; (4) Abdominal operations confirmed segment ulcer, necrosis of the small intestine, hyperplasia and stiffness of the intestinal wall; and (5) Pathological examinations suggested submucosal hemorrhage, necrosis, fibrosis and hyalinization of the vascular wall. Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.
  
  
  CONCLUSIONS
  Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications; timely exploratory laparotomy maybe an effective method for preventing and treating stress-induced intestinal necrosis.
authors.affiliation: Department of General Surgery, the People's Liberation Army General Hospital of Chengdu Command, Chengdu 610083, Sichuan Province, China.
authors.forename: Jia-Qing
authors.initials: JQ
authors.lastname: Gong
authors.forename: Guo-Hu
authors.initials: GH
authors.lastname: Zhang
authors.forename: Fu-Zhou
authors.initials: FZ
authors.lastname: Tian
authors.forename: Yong-Hua
authors.initials: YH
authors.lastname: Wang
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Yong-Kuan
authors.initials: YK
authors.lastname: Cao
authors.forename: Pei-Hong
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000328:Adult; D055866:Earthquakes; D006801:Humans; D007422:Intestines / Q000473:pathology*; D008297:Male; D009104:Multiple Trauma / Q000473:pathology*; D009336:Necrosis; D013315:Stress, Psychological / Q000473:pathology*