Traumatic Ileal Perforation with Mesenteric Tear
Case Presentation
A 45 year old male chronic alcoholic while under effect of alcohol was beaten with kicks and punches by two males. The patient had severe abdomen pain but he didn’t go to a medical facility. Two days after sustaining this blunt trauma to the abdomen he presented to emergency with persisting abdomen pain, abdominal distension, fever and decreased urine output. But initially he gave a vague history of self fall while walking and did not give any clear history which suggested force of trauma. At presentation, patient was hemodynamically stable but his Blood urea was 116 mg/dl and his Serum Creatinine was 2.8 mg/dl.
Perforated ileal segment was resected
Perforated ileal segment was resected Investigations
Focused assessment with sonography for trauma (FAST) revealed hemoperitoneum
NECT revealed mesenteric tear
Intraoperative Findings
Hemoperitoneum, approximately 750 ml of blood with clots was sucked
A large traumatic ileal perforation and minimal soiling with intestinal contents
A mesenteric tear in the corresponding area of ileal perforation with large clots surrounding the area
Operative Intervention
Hemoperitoneum was sucked
The perforation was closed temporarily with a clamp to prevent further soiling with intestinal contents
Mesenteric bleeder was clamped and ligated
Involved perforated segment of ileum was resected
End to end ileal anastomosis was done
Thorough warm saline wash was given
Two drains were kept, each in morrison’s pouch and pelvis
Postoperatively after 12 hours the urine output normalized and renal parameter came back to normal.
