A case report of a polytraumatized patient involved in a motor vehicle accident requiring multiple abdominal operations resulting in short bowel syndrome

Abstract text (incl. references and figure legends)

We present a case report of a 59-year old woman who suffered severe abdominal trauma when injured in a motor vehicle collision. She suffered from subarachnoid haemorrhage, fracture of a rib and the sternum, bilateral pneumothorax, rupture of the abdominal wall and dissection of the right common iliac artery with a large retroperitoneal haematoma.

After the initial resuscitation in the emergency department she underwent insertion of an aorto-bi-iliac endograft to stop the bleeding. Due to suspicion of small bowel injury on the CT scan she was operated, laparotomy revealed multiple small bowel perforations, ischemia of the sigmoid colon and destruction of the abdominal wall. The small bowel was resected and primary anastomoses were performed, the sigmoid colon was also resected and a colostomy was created. Negative pressure wound therapy was inserted to facilitate the reentry into the abdomen three days later, where an additional small bowel perforation was resected and an ischemic part of bowel was resected leaving in total 150cm of small bowel with an end ileostomy. At the time of the third reentry into the abdomen we inserted abdominal reapproximation anchor system to facilitate abdominal wall closure.

She was treated for short bowel with parenteral nutrition and one year after the accident she was reoperated and the ileostomy along with the mucous fistula were closed to establish continuity of the bowel, enabling gradual weaning off from parenteral nutrition.

This is a case of a complex patient that suffered from short bowel syndrome after undergoing multiple life-saving abdominal operations. However, after improving the nutritional and functional status, we managed to reconstruct the bowel and on this day she doesn't require parenteral nutrition anymore.

References: Singh A, Prasad G, Mishra P, Vishkarma K, Shamim R. Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre. Turk J Surg. 2021; 37(3): 277-85.

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