A Rare Cause of Colonic Obstruction: Transverse Colon Stricture after Blunt Trauma

Case Presentation

Austin Surg Case Rep. 2017; 2(1): 1013.

A Rare Cause of Colonic Obstruction: Transverse Colon Stricture after Blunt Trauma

Adem Y¹*, Murat C² and Kadri CM³

¹Department of Gastroenterology Surgery, Kocaeli Derince Training and Research Hospital, Turkey

²Department of General Surgery, Kocaeli Derince Training and Research Hospital, Turkey

³Department of Gastroenterology Surgery, Recep Tayyip Erdo─čan University, Turkey

*Corresponding author: Yuksel Adem, Department of Gastroenterology Surgery, Kocaeli Derince Training and Research Hospital, Turkey

Received: March 19, 2017; Accepted: April 04, 2017; Published: April 07, 2017

Introduction

Eighty percent of trauma cases are blunt trauma cases. Hollow organ injury is observed in 1% of patients with blunt abdominal trauma [1]. Intestinal organ injuries usually give signs and symptoms in the acute phase. However, rarely, complications such as perforation and stenosis due to blunt abdominal trauma can be observed in the late period [2,3]. In this article, we aimed to present the case of late transverse colon stenosis due to blunt abdominal trauma and to discuss the diagnosis and treatment management of such cases in this regard.

Case Presentation

A 20-year-old male patient presented to emergency clinic with complaints of abdominal pain, obstipation and constipation. Patient had a history of work accident, a falling heavy object on the abdomen, about 20 days ago. For this reason, patient was hospitalized and treated for 2 days at another health center. No pathological findings were detected in the examinations conducted at that time. On physical examination, there was a vertical scar of about 10cm, where the left midclavicular line intersects with arcus costarum. His abdominal pain was in colic style. There was no abnormal result in laboratory tests. Abdominal tomography scan results indicate dilation in the distal part of the transverse colon and in the proximal part of the small intestine (Figure 1). A colon stenosis was detected on the colonoscopy, which did not allow the passage of the endoscope through the transverse colon. Biopsies were obtained from this area. Endoscopic balloon dilatation was applied to the patient after the biopsy result was benign. The patient whose clinical findings were regressed was discharged with recommendations. Endoscopic dilatation was performed again 4 weeks after the first procedure. Patient presented again with partial mechanical intestinal obstruction findings, 3 months after the last dilatation procedure. It has been observed that narrowing which hardly allows passage of the endoscope on the area that previously dilated, was still exists. In response, it was decided for surgery. At the time of operation, it was observed that the distal part of the transverse colon was attached to the anterior wall of the abdomen together with the omentum (Figure 2). This area was released from the anterior wall of the abdomen and the patient underwent laparoscopic segmental transverse colectomy and reconstruction with lateral anastomosis (Figure 3). The postoperative follow-up was stable and patient discharged on the 5th day postoperatively. Pathologic examination of specimen revealed that the continuity of circulars and longitudinal sections of muscularis propria in the stenosis area disappeared and this area was filled with fibroblastic structure compatible with fibrosis. At the 4th postoperative month, the patient is followed without any problems.