Delayed perforation of the colon in blunt abdominal trauma

The authors describe three patients with similar clinical features and patterns of colonic injury following blunt abdominal trauma. Perforation was discovered 7 to 10 days after injury and was indicated by the clinical signs of systemic sepsis. A prominent sign of occult sepsis was post-traumatic pulmonary insufficiency. Blunt trauma to the colon was initially present but was not very impressive, consequently diagnosis was delayed. The large number of concomitant injuries and the subsequent sepsis led to a higher morbidity and mortality than in cases of penetrating injuries to the colon. The key to successful management of blunt colonic injuries is early diagnosis. Awareness of the type of injury and the magnitude of the deceleration force combined with the presence of persistent ileus may lead to earlier laparotomy.