Delayed Transverse Colon Stricture Following Blunt Abdominal Trauma: A Case Report With Diagnostic Dilemma

This case report describes a 26-year-old woman who developed a delayed transverse colon stricture following a motor vehicle crash (MVC). She was a restrained rear-seat passenger in a rollover collision and sustained blunt abdominal and back injuries, two right rib fractures, superficial lacerations, and T11-L1 vertebral injury requiring surgical management. Contrast-enhanced computed tomography (CT) performed after the MVC demonstrated no obvious bowel or solid visceral organ injury. Approximately 3 years later, she developed progressive abdominal pain, cramping, fullness, constipation, and a 10-pound weight loss. Colonoscopy demonstrated a severe, nontraversable stenosis of the transverse colon. Subsequent CT demonstrated marked stool burden and dilatation of the ascending and proximal transverse colon proximal to the stenotic segment. She later presented to the emergency department with worsening abdominal pain, nausea, and vomiting and was diagnosed with large bowel obstruction secondary to the transverse colon stricture. She underwent robotic-assisted transverse colon resection with colonic lavage and primary colo-colonic anastomosis. Histopathologic examination demonstrated moderately active chronic colitis with transmural inflammation, glandular architectural distortion, mucosal ulceration, and cryptitis, raising consideration of inflammatory bowel disease. However, no granulomas or dysplasia were identified. The postoperative course was uncomplicated, and at approximately 2 years of follow-up, she remained asymptomatic without recurrent gastrointestinal symptoms or other clinical features suggestive of inflammatory bowel disease. This case highlights the diagnostic challenge of distinguishing a delayed posttraumatic colonic stricture from inflammatory bowel disease when chronic inflammatory histopathologic changes are present in a patient with remote blunt abdominal trauma.