Bouliaris et al. Journal of Medical Case Reports 2011, 5:507 http://www.jmedicalcasereports.com/content/5/1/507 warranted in stable patients with free intra-abdominal fluid as a sole finding, who are otherwise fit and coop- erative. We suggest close monitoring of these patients, including continued physical examination along with further testing if there is any doubt. We would consider surgical intervention as the last resource in our medical quiver, and only in a deteriorating patient. Many other authors agree that a trace of free fluid in these patients (given no other signs of injury) is not associated with significant intra-abdominal injury and can be safely managed nonoperatively [18,19]. Our case supports the subclinical perforation theory, with the perforation prob- ably sealed by the adjacent sigmoid which led to the ileosigmoid fistula formation. This ileosigmoid fistula was the cause of the diarrheic episodes our patient experienced when the intraluminal pressure in the stric- tured ileum was raised. To the best of our knowledge, this combination of delayed ileum stricture and ileosig- moid fistula formation after BAT has not previously been described in the literature. The main differential diagnosis in these patients should be made from Crohn’s disease [9-11,20]. Conclusion Patients with BAT who have small amounts of intraperi- toneal fluid as the only finding on CT and are hemodyna- mically stable can be safely managed without surgical intervention. Delayed occurrence of post-traumatic small bowel stricture and ileosigmoid fistula is indeed a rare entity. Diagnosis of post-traumatic small bowel stricture could be difficult but general surgeons and emergency physicians should bear in mind this clinical manifestation and remain vigilant, especially when a patient presents with free intraperitoneal fluid after BAT on imaging, even if there are no signs of solid organ injury. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1General Surgery Department, General Hospital of Larissa, Greece. 2Department of General Surgery, 404 Military Hospital Larissa, Greece. 3Radiological Department, General Hospital of Larissa, Greece. Authors’ contributions BK performed the literature search and was the chief author in writing the manuscript. DK performed the literature research and co-authored the paper. KS was the attending surgeon of the case and checked the paper. 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Lane TM: Small bowel obstruction after blunt trauma. J R Soc Med 2000, 93(9):498. doi:10.1186/1752-1947-5-507 Cite this article as: Bouliaris et al.: Ileosigmoid fistula and delayed ileal obstruction secondary to blunt abdominal trauma: a case report. Journal of Medical Case Reports 2011 5:507.