図１４〜図１６でdensityの高い腹水（※）は血性腹水の可能性が高い，図６〜図８の△はガスとニボーを形成した腸管外の液貯留で，図８〜図１０の▲は連続性を確認すれば腸管ではなく，densityが周囲の筋肉より明らかに高く血腫（凝血塊）と思われる．図１０〜図１２の↑は同様に腸管外の所見で，糞便様であり，S状結腸（図１３の1〜図７の8）の穿孔を示唆する．手術で骨盤腔内に約400mlの血性腹水を認めた．Ｓ状結腸が腹壁に癒着しており，剥離すると2.5cm大の穿孔があり後腹膜内に膿瘍を形成していた．Hartmann手術を行った．

文献考察：大腸損傷は鈍的腹部外傷例の1．0％，全消化管穿孔例の30．3％，死亡率は18．9％
J Trauma. 2003 Nov;55(5):906-12.
Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.
Williams MD, Watts D, Fakhry S.

BACKGROUND: Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries. METHODS: Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review. RESULTS: Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p 追記：大腸穿孔例の術後合併症は36．0％に見られ，肺炎：19．8％，敗血症：15．7％，ARDS：9．6％，創感染：8．1％，膿瘍形成：7．8％，腎不全：6．4％であった．