Cirujano General

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirujano General >Year 2009, Issue 3

Terrazas EF, Mancera SC, Galindo NA
Sigmoid colon perforation due to blunt trauma. Management with hand-assisted laparoscopic surgery
Cir Gen 2009; 31 (3)

Language: Español
References: 38
Page: 186-191
PDF: 4. Kb.

Full text


Objective: To present an infrequent case of sigmoid colon rupture due to blunt abdominal trauma and its management with hand-assisted laparoscopic surgery. Setting: Third level health care hospital. Design: Case report and review of the literature. Description of the case: Male patient, 52 years old, who sufferred a blunt abdominal trauma 10 days before being admitted in the emergency service of our institution. He referred difuse abdominal pain, with a left-sided hematoma reaching the iliac fossa, without leukocytosis, with 87% neutrophiles. CAT scan was performed and revealed free air in the abdominal cavity and a purulent collection around the sigmoid colon. He was subjected to hand-assisted laparosocopy, finding perforation of the sigmoid and a pericolon abscess. The perforated sigmoid was resected, and a Hartmann procedure with colostomy was performed. The patient evolved satisfactorily, and was discharged on the 5th day. Intestinal transit was restituted by end-to-end anastomosis by means of hand-assisted laparoscopy after 11 weeks. He evolved satisfactorily and was discharged on the 5th post-operative day. Conclusions: Hand-assisted laparoscopy can be useful and satisfactory to manage perforated injuries of the colon caused by blunt abdominal trauma. This resource must be further evaluated in comparative prospective studies.

Key words: Hand assisted laparoscopic surgery, perforation, colon, large bowel, laparoscopy, Hartmann’s procedure, colostomy.


  1. Stevens SL, Maull KI. Small bowel injuries. Surg Clin North Am 1990; 70: 541-60.

  2. Fabian TC, Croce MA. Abdominal trauma. In: Mattox KL, Feliciano DV, Moore EE, editors. Trauma. 4th ed. Philadelphia7 McGraw Hill; 2000: 583-602.

  3. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin North Am 2007; 25: 713-33.

  4. Mendez C. Blunt abdominal trauma. In: Cameron JL, editor. Surgical Therapy. 6th ed. Philadelphia, Mosby; 1998: 906-11.

  5. Fabian CT, Croce MA. Intestinal injury. In: Cameron JL, editor. Surgical Therapy. 6th ed. Philadelphia Mosby; 1998: 935-7.

  6. Ceci F, Picchio M, Corelli S, Gammardella P, Santilli M, Stagnitti F, et al. Sigmoid colon injury due to blunt abdominal trauma. A Case report. G Chir 2006; 27(6-7): 259-261.

  7. Yama N, Kimura Y, Tatsumi H, Kihara C, Kurimoto Y, Narimatsu E, et al. Nominal free air in the left inguinal fossa due to perforation of the sigmoid colon in a case of blunt abdominal trauma: CT diagnosis. Abdom Imaging 2006; 31(1): 57-58.

  8. Rood LK. Blunt colon injury sustained during a kickboxin match. J Emerg Med 2007; 32(2): 187-9.

  9. Williams RD, Sargent FT. The mechanism of intestinal injury in trauma. J Trauma 1963; 3: 288-94.

  10. Brasel KJ, Nirula R. What mechanism justifies abdominal evaluation in motor vehicle crashes. J Trauma 2005; 59: 1057-61.

  11. Lublin M, Chauvin S, Kashani M, Ibrahim I, Kahn M. Delayed colonic stricture and obstruction after abdominal blunt trauma: a case report and review of the literature. J Trauma 2004; 57(1): 193-5.

  12. Bosworth BM. Perforation of the small intestine from nonpenetrating abdominal trauma. Am J Surg 1948; 76: 472-82.

  13. Burney RE, Mueller GL, Coon WW, Thomeas EJ, Mackenzie JR. Diagnosis of isolated small bowel injury following blunt abdominal trauma. Ann Emerg Med 1983; 12: 71-4.

  14. Miranda E, Arroyo A, Ronda JM, Muñoz JL, Alonso C, Martínez-Peñuelas F, et al. Perforación tardía del ciego y colon sigmoides posterior a traumatismo abdominal cerrado en un enfermo politraumatizado. Rev Esp Anestesiol Reanim 2007; 54(6): 381-3.

  15. Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intraabdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 2002; 52: 420-5.

  16. Guarino J, Hassett JM Jr, Luchette FA. Small bowel injuries: mechanisms, patterns, and outcome. J Trauma 1995; 39(6): 1076-80.

  17. Hoff WS, Holevar M, Nagy KK, Patterson L, Young JS, Arrillaga A, et al. Eastern Association for the Surgery of Trauma. Practice management guidelines for the evaluation of blunt abdominal trauma: the EAST practice management guidelines work group. J Trauma 2002; 53: 602-15.

  18. Fischer RP, Beverlin BC, Engrav LH, Benjamín CI, Perry JF Jr. Diagnostic peritoneal lavage: fourteen years and 2,586 patients later. Am J Surg 1978; 136: 701-4.

  19. Tso P, Rodríguez A, Cooper C, Mitello P, Mirvis S, Badellino MM, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma 1992; 33: 39-44.

  20. Farahmand N, Sirlin CB, Brown MA, Shragg GP, Fortlage D, Hoyt DB, et al. Hypotensive patients with blunt abdominal trauma: performance of screening US. Radiology 2005; 235: 436-43.

  21. Donohue JH, Federle MP, Griffiths BG, Trunkey DD. Computed tomography in the diagnosis of blunt intestinal and mesenteric injuries. J Trauma 1987; 27: 11-7.

  22. Gay SB, Sistrom CL. Computed tomographic evaluation of blunt abdominal trauma. Radiol Clin North Am 1992; 30: 367-88.

  23. Livingston DH, Lavery RF, Passannante MR, Fry DE, Shurnik JH, Fabian TC, et al. Admission or observation is not necessary after a negative abdominal computed tomographic scan in patients with suspected blunt abdominal trauma: results of a prospective, multiinstitutional trial. J Trauma 1998; 44: 273-82.

  24. Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg 1994; 168: 670-5.

  25. Nghiem HV, Jeffrey RB Jr, Mindelzun RE. CT of blunt trauma to the bowel and mesentery. Semin Ultrasound CT MR 1995; 16: 82- 90.

  26. Terrazas-Espitia F, Galindo-Nava A, Ruiz-Patiño C, Carrera-Muñoz A, Martínez-Manrique JJ. Cirugía laparoscópica asistida con la mano, en procedimientos de colon. Cir Gral 2009; 31(1): 39-45.

  27. Martel G, Boushey RP, Marcello PW. Hand-assisted laparoscopic colorectal surgery: an evidence-based review. Minerv Chir 2008; 63(5): 373-83.

  28. Iqbal M, Bhalerao S. Current status of hand-assisted laparoscopic colorectal surgery: a review. J Laparoendosc Adv Surg Tech A 2007; 17(2): 172-9.

  29. Cima RR, Pattana-arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH. Experience with 969 minimal access colectomies: the role of hand-assisted laparoscopy in expanding minimally invasive surgery for complex colectomies. J Am Coll Surg 2008; 206(5): 946-52.

  30. Ross HM, Simmang CL, Fleshman JW, Marcello PW. Adoption of laparoscopic colectomy: results and implications of ASCRS hands-on course participation. Surg Innov 2008; 15(3): 179-83.

  31. Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, et al. Hand-assisted laparoscopic vs laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 2008; 51(6): 818-28.

  32. Keck JO, Collopy BT, Ryan PJ, Fink R, Mackay JR, Woods RJ. Reversal of Hartmann’s procedure: effect of timing and technique on ease and safety. Dis Col Rectum 1994; 37(3): 243-8.

  33. Sosa JL, Sleeman D, Puente I, McKenney MG, Hartmann R. Laparoscopic-assisted colostomy closure after Hartmann’s procedure. Dis Colon Rectum 1994; 37(2): 149-52.

  34. Rosen MJ, Cobb WS, Kercher KW, Sing RF, Heniford BT. Laparoscopic restoration of intestinal continuity after Hartmann’s procedure. Am J Surg 2005; 189(6): 670-4.

  35. Khaikin M, Zmora O, Rosin D, Bar-Zakai B, Goldes Y, Shabtai M, et al. Laparoscopically assisted reversal of Hartmann’s procedure. Surg Endosc 2006; 20(12): 1883-6.

  36. Mazeh H, Greenstein AJ, Swedish K, Nguyen SQ, Lipskar A, Weber KJ, et al. Laparoscopic and open reversal of Hartmnn’s procedure – a comparative retrospective analysis. Surg Endosc 2009; 23(3): 496-502.

  37. Crawford DL, McVay WB. Delayed presentation of colonic implement injury by picture frame glass fragment treated using hand-assisted laparoscopic colectomy. Surg Laparosc Endosc Percutan Tech 2008; 18(6): 619-21.

  38. Sotomyor RK, Arboleda B. Experience with hand-assisted laparoscopic surgery of the colon. Bol Asoc Med P R 2008; 100(1): 13-18.

>Journals >Cirujano General >Year 2009, Issue 3

· Journal Index 
· Links 

Copyright 2019