A Case of Delayed Diagnosis of Small Bowel Perforation in a Patient with Head Injury and Open Fracture of the Femur Who Presented with Consciousness Disturbance and Hemorrhagic Shock

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  • 頭部外傷による意識障害と大腿骨開放骨折による出血性ショックを合併し遅発性に明らかとなった外傷性小腸損傷の1 例
  • トウブ ガイショウ ニ ヨル イシキ ショウガイ ト ダイタイコツ カイホウ コッセツ ニ ヨル シュッケツセイ ショック オ ガッペイ シチハツセイ ニ アキラカ ト ナッタ ガイショウセイ ショウチョウ ソンショウ ノ 1レイ

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Abstract

<p>The patient was a man in his 40s who had sustained injuries in a head-on collision of his car （which he was driving, with the seat belt on）with an oncoming truck. We diagnosed the patient as having hemorrhagic shock due to an open fracture of the femur. Damage control resuscitation was started, and damage control orthopedics（external fixation）was immediately performed. We suspected small bowel perforation, and computed tomography（CT）was performed 6 h after the patient’s arrival; however, no free air was detected. Also, no signs of peritoneal irritation were apparent on physical examination. Intraabdominal free air was detected at 18 h after arrival and emergency laparotomy was performed. Small bowel perforation is not always detected on arrival. In the present case, the signs of peritoneal irritation were presumably not apparent, because of the patient had consciousness disturbance arising from the brain injury. We must monitor the CT findings in patients with suspected small bowel injury and consciousness disturbance, regardless of the abdominal findings. Furthermore, appropriate resuscitation, including to improve the coagulation ability of the patient for surgery, is important for patients with hemorrhagic shock who are considered to be potential candidates for surgery.</p>

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