腹部を蹴られ空腸離断をきたした腹部鈍的外傷の１例

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  • Blunt Abdominal Trauma by Kicking as a Cause of Jejunal Transection.

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Jejunal transection produced by a blow inflicted by a human is relatively rare. We report a case of jejunal transection following blunt abdominal trauma. The patient was a 69-year-old man with alcohol dependency syndrome who after he had drunk a large guantity of alcohol and quarreled with his 22-year-old daughter was kicked in the abdomen four times with her heel. Although he complained of abdominal pain, there were no signs of peritonitis, no abnormal laboratory data, and no abnormal X-ray or abdominal CT findings. Eight hours later, rebound tenderness was noted in the abdomen, the laboratory data showed evidence of an inflammatory reaction, and abdominal X-ray and CT images revealed intraperitoneal free gas and ascites. A diagnosis of acute peritonitis secondary to gastrointestinal perforation was made, and emergency laparotomy was performed 11 hours after the trauma. The jejunum was found to have been transected 45cm distal to the ligament of Treitz. Other organs were intact. After resecting both stumps of the jejunum, primary end-to-end anastomosis, construction of a tube jejunostomy, and peritoneal lavage with drainage were performed. Although wound infection and dehiscence occurred, the patient was discharged 40 days after surgery. It is important to carefully monitor patients with blunt abdominal trauma who have no signs of peritonitis initially.

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