Nuzhat Faruqui, Tariq Mehmood, M Saeed Quraishy.
Post Traumatic small Bowel Stricture: A case report.
J Surg Pak Jan ;6(4):38-9.

An unusual case of delayed post-traumatic stricture of the intestine localized in the mid jejunum, resulting from blunt abdominal trauma is presented. The cause of the stricture was localized mesenteric ischaemia. At operation, the stricture was resected and the patient made an uneventful recovery.

CASE REPORT: A 45 years old man was involved in a road traffic accident while driving a truck. He presented to a local hospital with severe abdominal pain and tenderness but no signs of peritonitis. All investigations including a C.T scan of abdomen appeared normal. The patient did not have any other injuries and was treated conservatively. His abdominal pain gradually decreased and he was sent home. Four months later, he presented with increasing colicky abdominal pain especially after meals and abdominal distention. His medical history was insignificant and he had no history of gastrointestinal disease. Physical examination was unremarkable. Ultrasound abdomen revealed an isolated long, tight 9-10 cms stricture involving jejunal loop with marked distention of proximal jejunum (Fig.1). This was confirmed by small bowel barium study (Fig.2). At laparotomy, small bowel mesentery at that level was scarred. Resection of the involved segment of jejunum with primary anastomosis was performed. The patient had uneventful recovery and was sent home.

Pathological examination of the excised gut stricture revealed almost complete ulceration of the mucosa with replacement by granulation tissue associated with transmural chronic inflammation and formation of lymphoid follicles reaching up to serosa. Features consistent with a localized ischemic process.

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