Case Reports in Emergency Surgery and Trauma

Lower gastrointestinal bleeding as a rare manifestation of small bowel and colon tuberculosis: a case report

2025-08-04T11:35:50+00:00

Tuberculous enteritis (TE) is an exceptionally rare cause of lower gastrointestinal (GI) bleeding, especially in elderly patients. Its clinical presentation can mimic more common conditions such as diverticular disease, malignancy, or inflammatory bowel disease, making early diagnosis challenging. This case concerns an 89-year-old female patient who was transferred from the Internal Medicine Department to our clinic due to persistent lower GI bleeding. The patient underwent two gastroscopies, which revealed no significant findings, and two colonoscopies. The first colonoscopy showed diverticula in the descending colon, while the second identified a 1 cm ulcer with a whitish coating in the transverse colon. A computed tomography (CT) scan revealed pulmonary consolidation, atelectasis, and intraperitoneal fluid, along with sigmoid diverticula. Due to ongoing hemodynamic instability, the patient underwent urgent subtotal colectomy and terminal ileostomy. Intraoperative findings included blood clots filling the ileum and colon, wall thickening, multiple diverticula, and ascitic fluid. Histopathological analysis confirmed tuberculosis (TB) with the presence of epithelioid granulomas.

Colon perforation from an uncommon cause: a case report

2025-08-04T11:35:51+00:00

Pelvic fractures are frequently associated with concomitant injuries to intra-abdominal and genitourinary structures. We report an unusual case of colonic perforation secondary to entrapment of the sigmoid colon within a complex pelvic fracture. A 59-year-old male sustained a high-energy blunt trauma following a motor vehicle rollover. Upon presentation to the Emergency Department, he was responding with an intact airway and hemodynamically normal and stable. Auscultation revealed normal and symmetrical breath sounds bilaterally (SpO₂ 98%). The patient was alert, oriented, and scored 15/15 on the Glasgow Coma Scale. Physical examination revealed pelvic instability. Whole-body computed tomography (CT) demonstrated an anteroposterior compression (APC) Type III pelvic ring injury with herniation and perforation of the sigmoid colon into the fracture site, accompanied by free air. The patient underwent emergency exploratory laparotomy, which confirmed the diagnosis. A sigmoidectomy with Hartmann’s procedure was performed. Definitive pelvic stabilization was achieved in a subsequent operative session. Incarceration of bowel loops within pelvic fractures is exceedingly rare but represents a surgical emergency due to the risk of fulminant sepsis and mortality. Early radiologic identification and prompt surgical management are imperative. A high index of suspicion is warranted in patients with complex pelvic fractures, particularly in the presence of free intraperitoneal air or signs of peritonitis.

A rare case of acute abdomen caused by diverticulum perforation in the jejunum

2025-08-07T09:46:39+00:00

Diverticulitis of the small bowel is a rare condition that is typically asymptomatic. This study presents a case of diverticulitis of the jejunum in a 70-year-old male. The patient presented to our clinic with acute abdominal pain. Abdominal CT revealed the presence of a diverticulum in the jejunum with mesenteric air and fat stranding. Due to clinical deterioration, the patient was taken to the operating room for surgical exploration. Exploratory laparoscopy revealed multiple diverticula in the proximal jejunum over a length of 50 cm, with signs of diverticulitis in one segment. The laparoscopic procedure was converted to an open approach. A segmental resection of the small bowel was performed, which included the inflamed portion and most of the diverticulum. Laparoscopy and laparotomy are both recommended for managing complications associated with diverticulitis in the jejunum. In cases with complications such as perforation and abscess formation, segmental resection is the preferred approach.