Analysis of Misdiagnosis of Incarcerated Small Intestine with Rupture Caused by Traumatic Vertebral Fracture

ZHANG Xiao-yu; KANG Xiao-ning; LIU Chao; LU Meng; WANG Zun-yi

doi:10.3969/j.issn.1002-3429.2018.05.008

Abstract：Objective To investigate the clinical features,diagnostic approach,causes of misdiagnosis and preventive measures of incarcerated small intestine with rupture caused by trauma. Methods The clinical data of 1 cases of incarcerated small intestine caused by traumatic vertebral fracture,which had been misdiagnosed,were ret-rospectively analyzed,and the relevant literature was reviewed. Results The patient presented to our department for multiple injuries at the head and face as well as at chest and abdomen due to the fall 5 days before. He was initially diagnosed as fracture at anterior border of vertebral body of the third lumbar vertebrae and paralytic ileus on the basis of radiology and other examinations in another hospital, and symptomatic treatment with enema was unsatisfactory. He was admitted to our hospital due to aggravation of the disease. CT examination showed fracture at anterior border of vertebral body of the third lumbar vertebrae. At 20 cm below the flexor ligament,the jejunum was incarcerated in the fracture site and ruptured. After oral administration of the contrast agent, a small amount of contrast agent got through the incarcerated intestine,and fluid accumulation and pneumatosis were noted at the retroperitoneum. There was dilation of intestine proximal incarcerated area,but emptiness of intestine distal incarcerated area. The diagnosis was incarcerated intestine with rupture. Surgical resection of ruptured intestinal canal and repair of the peritoneum were performed. The patients was discharged after perfect healing postoperatively. Conclusion Incarceration of small intestine with rupture caused by truma is a rare disease with serious consequences. Detailed inquiry of history, careful physical examination,strengthened understanding of the CT signs of the disease,and timely medical examina-tions may help to reduce or avoid misdiagnosis and mistreatment.