Delayed Perforation of the Sigmoid Colon Due to A Seat Belt Injury

Delayed small bowel perforation is uncommon after blunt abdominal trauma, including trauma caused by a seat belt. Delayed perforation of the colon is even rarer. A 21-year-old man suffered from multiple facial, thoracic, and abdominal ecchymoses after a car accident. Contrast-enhanced computed tomography (CT) of his brain, chest, and abdomen was performed at another hospital, but did not reveal any internal bleeding or hollow organ perforation. The patient was then transferred to our hospital. Initially, no special complaint was noted. However, the sudden onset of acute abdominal pain occurred 2 days later. CT revealed diffuse wall thickening of the ileum and sigmoid colon. Pockets of intraperitoneal air were identified, especially around the distal ileum and sigmoid colon. Hollow organ perforation at 1 of these 2 locations was suspected. Emergent laparotomy revealed avulsion of the sigmoid mesentery and perforation of the sigmoid colon. This incident should be kept in mind when deciding on a differential diagnosis for a patient suffering from acute abdomen days or weeks after blunt abdominal trauma. Correspondence Author to: Kwok-Wan Yeung Department of Radiology, Fooyin University Hospital, Pingtung, Taiwan No. 5, Chung-Shan Road, Tung-Kang, Pingtung 928, Taiwan J Radiol Sci 2012; 37: 127-132 Delayed perforation due to a seat belt injury 128 J Radiol Sci September 2012 Vol.37 No.3 intracranial, intrathoracic, or intraabdominal regions or the pneumoperitoneum. After resuscitation, he was transferred to our emergency department (3 hours later) and admitted. His body temperature was 38.2°C. Blood analysis was as follows: white blood cell (WBC) count = 26700/μl (normal range=3900-10600/μl); creatine kinase (CK) = 1440 U/L (normal range = 55-170 U/L); CK-MB = 25 U/L (normal < 16 U/L); and troponin I = 0.34 μg/L (normal < 0.11 μg/L). Urinalysis detected presence of occult blood with 2+ value. Transthoracic echocardiography revealed trivial aortic and mitral regurgitation and mild pulmonary regurgitation. Electrocardiogram showed normal sinus rhythm. On