A 36-year-old male presented after a road traffic accident (RTA) with blunt abdomen injury and a right tibiofibular fracture. He has the pulse of 72/min and blood pressure (BP) of 112/70 mm Hg with a normal FAST exam. The patient was transferred to the orthopedic unit for further management but developed complaints of vomiting and constipation with abdominal distension over the next 3 days. Abdominal X-ray [] revealed multiple air fluid levels and a contrast CT with oral and intravenous (IV) contrast revealed an obstruction at the jejunoileal junction. A decision was taken to do a diagnostic laparoscopy on day 4 after injury, which was converted to open laparotomy due to findings of internal herniation of ileal loops through the transverse mesocolon. This herniated ileal loop had vascular compromise so it was resected, and an ileo-ileal end to end anastomosis was done. The postoperative period was uneventful, and the patient was discharged on postoperative day 7.
A 23-year-old male presented with deceleration injury following an RTA. His hemodynamic parameters were within the normal range; he had a pulse of 80/min and a BP of 110/78 mm Hg. Examination revealed a soft abdomen. The FAST exam was positive, and a CT with oral and IV contrast revealed a completely devascularized spleen. The patient was conservatively managed and started on a liquid diet but developed abdominal pain with associated fever after a week. An exploratory laparotomy was done 8 days after injury, and a splenectomy was done for splenic infarction with abscess formation. He had an uneventful postoperative period and went home on postoperative day 7.