Isolated Sigmoid Colon Perforation in the Setting of Blunt Abdominal Trauma: A Case Series

Abstract

Isolated colon injuries following blunt abdominal trauma have been reported with an incidence of 0.1-0.5 %, with sigmoid colon involvement being a rare entity. The sigmoid colon is reportedly involved only in 34.8% of isolated colonic injuries. The most common cause of colonic injuries is motor vehicle accidents. Contrast-enhanced computed tomography has a role in blunt trauma-induced bowel injury evaluation, with 82% accuracy and 64% sensitivity, but its role in the diagnostic evaluation of colonic injuries is controversial. Surgical treatment comprises primary closure, resection with or without anastomosis, and/or colostomy formation. Primary anastomosis is often favored, while colostomy creation is generally required if devascularized bowel segments present or infrequently in hemodynamic instability scenarios. Subsequent gross presentation, treatment delays due to diagnostic difficulties, and scarcity of management guidelines contribute to high morbidity and mortality. Additional research is required to accurately define patient presentation and explore the benefits of different surgical treatment options. Hereby is a case series comprising three adult male patients who presented with delayed diffuse severe abdominal pain and distension following blunt abdominal trauma. Computed tomography evaluation in the latter two had findings suggestive of pneumoperitoneum. Post resuscitation, exploratory laparotomy done in each patient denoted isolated sigmoid colon perforation with and without associated mesenteric hematoma. The decision of primary closure, resection with rectosigmoid anastomosis, and resection with end colostomy creation was taken in respective cases based on intraoperative findings of contamination, vascularity, and hemodynamics. Previously documented reports have mentioned findings of associated intra-abdominal solid organ injuries, which were absent in the present case series.