Delayed Stricture of the Small Bowel After Blunt Abdominal Trauma in a Child

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  • 小児の鈍的腹部外傷による遅発性小腸狭窄症の 1 例と本邦報告例の集計

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We report a case of delayed stricture of the small bowel after blunt trauma in an 11-year-old girl and review reported cases in Japan. The patient was injured when the handle of her bicycle hit her lower abdomen. Nine days after the accident, she developed intermittent abdominal pain and vomiting and was hospitalized elsewhere. She underwent an appendectomy because there was a risk of acute appendicitis, however, no inflammatory changes were seen in the appendix ; although there were a few portions of spastic small intestine without organic changes. She was referred to our hospital because of persistent symptoms of partial bowel obstruction. A small bowel contrast study demonstrated a stenosis in the middle portion of the small intestine with proximal distention. A second laparotomy was performed one month after the accident and a segment of stenotic small intestine 270 cm proximal to the ileocecal valve was resected. Microscopic examination of the stenotic bowel revealed ulceration, submucosal inflammation, and fibrosis. Delayed small bowel stricture after a blunt trauma is extremely rare in children. There have only been 44 cases including this case reported in Japan, and of these only 6 were pediatric cases. Post-traumatic stricture of the small bowel should be suspected in patients who develop signs and symptoms following blunt abdominal trauma. Surgical treatment is indicated because the lesion involves organic change with subsequent fibrosis.

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