Stress-induced intestinal necrosis resulting from severe trauma of an earthquake

AIM：To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS：Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS：Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics：（1） Multiple severe trauma events with no direct penetrating gastrointestinal injury;（2） Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;（3） Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;（4） Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and（5） Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION：Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.