Accidental Blunt Abdominal Injury Causing Multiple Small Bowel Loops’ Avulsion from the Mesentery and Dismembered Colon

ABSTRACT

A 50-year-old male, truck driver, met with an accident with blunt steering wheel injury to the abdomen with no external marks ofinjury over the abdominal wall. He had severe abdominal pain with tossing up in bed. As the abdomen showed no external marksof injuries, strikingly, abdominal palpatory findings were prominent with severe tenderness in the left side umbilical and pelvicregions. He had consumed heavy food with liquids within an hour before the accident. He collided with another stationary lorry;thus, he received massive blow to his abdomen with the steering wheel. He displayed the signs of hemorrhagic shock on arrivalto the emergency care. Computed tomography scan confirmed moderate hemoperitoneum with multiple bowel perforations. Onexploratory laparotomy, multiple jejunal and ileal loops were found completely avulsed from the base of the mesentery, makingthem completely devascularized along with dismembered descending colon from the sigmoid. Resection of nonviable smallbowels and end-to-end jejunoileal anastomosis was done. Colocolic anastomosis was performed after adequate descendingcolon mobilization with protective loop ileostomy in the right lower quadrant. The patient had developed wound infection; hence,he was put on daily dressing. Gradually, the patient improved and was discharged with functioning ileostomy.