台灣外科醫學會雜誌

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篇名	Delayed perforation of the colon after blunt abdominal injury: Two case reports with reviews
作者	Hao-Hsien Lee, Ko-Chin Wang, Po-Chang Huang, Tune-Yie Shih, Yi-Huei Uen
卷期/出版年月	35卷4期 (2002/8)
頁次	193-197
摘要	A perforted colon after a blunt abdominal injury is rare. Although delayed colonic perforation may reflect a missed diagnosis, the perforation may happen and lead to a poor outcome. We report two patients with multiple traumas complicated by delayed perforation of the colon. A 34-year old man sustained multiple lacerations as well as a fibular fracture and peroneal nerve injury. No abdominal symptom or sign was visible on the day of admission. He had a normal bowel movement and diet during the early period after primary repair. Generalized peritonitis occurred 5 days after the injury. Emergency laparotomy disclosed a 2x2 cm aperture of the sigmoid colon and rupture of the mesentery of the jejunum. Hartmann’s procedure was smoothlyperformed. Another 45-year-old male suffered from multiple lacerations of the extremities and peritonitis. Rupture in the mesocolon making a tear in the superior mesenteric vein (SMV) and mid-colic artery (MCA) were marked during surgery. Lateral repair of the SMV and ligation of the MCA were smoothly performed. Fecal material from the drainage tube with sepsis necessitated a second laparatomy 15 days later. Necrosis of the transverse colon near the hepatic flexure area was found. After the resection of the necrotic segment and the establishment of the ostomies, the patient recovered. Early diagnosis of delayed perforation of the colon can be made only with a high level of suspicaion as well as careful observation and asseddment. The treatment and outcome for delayed intraperitoneal colonic perforation are the same as those for acute colonic perforation.
關鍵詞	Delayed perforation of the colon, blunt abdominal injury
分類	Case Report