図１で上腹部に遊離ガスや腹水はなく，肝臓と脾臓に損傷を認めない．図２に少量の（↑），骨盤腔には相当量の腹水（※）がある．図２〜図９の空腸（J）は壁肥厚を示し，図９と図１０で脂肪組織の濃度上昇を認める（△）ので空腸損傷を疑い，8時間以内に手術すべく（下記文献を再掲）4, 5時間後にCTの再検査を行うべきである．

腹部所見で圧痛だけだから帰宅させたが，腹痛増強し5時間後に再来院した．体温：37.2℃，左上腹部に圧痛，反跳痛と筋性防御がある．5時間後のCT図Aで遊離ガス（▲）を，図Bで空腸（J）の壁肥厚が明白になり，図Cで腹水（※）が増量している．手術でTreitz靱帯から15cmの部位で空腸穿孔を認め，閉鎖した．合併症なく1週間で治癒退院した．

文献考察：鈍的外傷による小腸穿孔は受傷後8時間を過ぎると死亡率と術後合併症が急増する．
J Trauma. 2000 Mar;48(3):408-14; discussion 414-5.
Relatively short diagnostic delays (.
Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D.

OBJECTIVE: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. METHODS: Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. CONCLUSION: Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.　PMID: 10744277