Bouliaris et al. Journal of Medical Case Reports 2011, 5:507 http://www.jmedicalcasereports.com/content/5/1/507 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Ileosigmoid fistula and delayed ileal obstruction secondary to blunt abdominal trauma: a case report Konstantinos Bouliaris1, Dimos Karangelis2*, Konstantinos Spanos1, Stylianos Germanos1, Evangelos Alexiou3 and Anargyros Giaglaras1 Abstract Introduction: Abdominal trauma is a source of significant mortality and morbidity. Bowel injury as a result of blunt abdominal trauma is usually evident within hours or days of the accident. Case presentation: A 38-year-old Caucasian Greek man presented with a subtle and delayed small bowel obstruction caused by a post-traumatic ileosigmoid fistula and ileal stricture four months after a road traffic accident. Conclusion: Delayed occurrence of post-traumatic small bowel stricture and ileosigmoid fistula is an uncommon surgical emergency. General surgeons as well as emergency physicians should bear this manifestation in mind should a patient return to the hospital several weeks or even years after blunt abdominal trauma with symptoms or signs of bowel obstruction. Introduction The abdomen is the third most commonly injured body part following trauma [1]. In 85% of cases it is the result of blunt trauma [2,3]. Solid organs, such as the liver and spleen, are the most frequently injured; injuries to the bowel or mesentery are rare. Although small bowel injury has been reported to be the third most common injury in blunt abdominal trauma (BAT), it was diagnosed in only 1.1% of admissions after blunt injury. Only 0.3% of patients had a small bowel perforation in a multi-institu- tional study [4]. In the absence of shock and peritonitis, patients with BAT may be treated conservatively and observed with computerized tomography (CT) [5]. How- ever, on rare occasions such patients can present later on with symptoms and signs of small bowel obstruction or perforation [6-13]. We present a case of ileal stricture and an ileosigmoid fistula as a result of BAT. Case presentation A 38-year-old Caucasian Greek man presented to our emergency department complaining of a three-month * Correspondence: dimoskaragel@yahoo.gr 2Department of General Surgery, 404 Military Hospital Larissa, Greece Full list of author information is available at the end of the article history of intermittent abdominal pain and frequent epi- sodes of diarrhea. He had a history of a previous admis- sion in another surgical department four months earlier for BAT after a road traffic accident. At that time he underwent an abdominal ultrasound, which showed no intraperitoneal fluid or solid organ injury, and he was admitted for observation. We also recovered from his discharge note that, during the first 48 hours of his hos- pitalization, a progressive decrease in the hematocrit value from 41% to 28% was noted. An abdominal CT scan at that time showed a small amount of fluid in the rectovesical pouch with no solid organ abnormalities and a large hematoma in the subcutaneous fat tissue on both lumbar areas. He was hemodynamically stable and he had a transfusion with one unit of packed red blood cells and three units of fresh frozen plasma. He improved rapidly with conservative treatment and was discharged on the fifth day, asymptomatic. One month later he started to have episodes of vague abdominal pains and frequent episodes of diarrhea after meals. Our patient also mentioned that during that four-month per- iod he had lost 10 kg in weight. Due to his fear of the resulting diarrhea, he had cut down on eating. On our patient’s current admission he complained of a colicky pain at the periumbilical region for the last 24 © 2011 Bouliaris et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.