[Ischemia-related small intestine perforation 15 days after car accident. Fate or avoidable complication?]

Intraabdominal organ lesions after blunt abdominal injuries often are missed, especially in the contest of a polytrauma because of the absence of obvious clinical injury signs, difficult examination conditions of an intubated patient and the possibility of secondary development of lesions. For an exact recognition of the abdominal injuries a standard diagnostic procedure is necessary. Clinical and laboratory parameters which determine the circulatory situation, initial abdominal ultrasound, x-ray and follow up examinations are indispensable. In equivocal situations CAT scan respectively angiography are recommended. The correct initial diagnosis of intestinal perforations still is problematic and requires repeated examinations. We report the case of a patient with initial blunt abdominal injury and a non dislocated Weber-A-fracture after a car accident. 15 days after trauma the patient was seen with the clinical signs of an acute abdomen. After emergency laparotomy an ischemic necrosis of the ileum, covered with net, was seen.