The accuracy of CT in the detection of injuries of the solid viscera after blunt trauma is well established, but the value of CT in diagnosing bowel rupture resulting from blunt trauma is controversial. His post-operative recovery was uneventful. Right hemicolectomy with double barrel stoma was done. Intraoperatively there was transection of the ascending colon near the hepatic flexure with faecal contamination surrounded by the small bowel and the mesentery. His condition worsened in the ward and a laparotomy was performed. He presented to the hospital on the 5 th day and computerised tomography (CT) of the abdomen was done which was suggestive of a Gastro intestinal stromal tumour (GIST)/ Hematoma. We present a case of a 21-year-old male who sustained trauma to the abdomen following hit by a donut boat. BAT can be silent initially and as time progresses can cause fatal complications. Injury to the hollow viscus is less common in blunt trauma when compared to penetrating abdominal trauma. Blunt Abdominal trauma (BAT) can occur as a part of polytrauma or in isolation. Abdominal injuries occur in approximately 41% of all trauma patients. The small intestine swung well toward the region of the gall bladder, but there was no obstruction.Industrialization, changing life style, newer modes of recreational sports like jet ski, buggy rides, donut boating has added to the woes of trauma by increasing the morbidity and mortality. This was a most unusual position, but there was no definite pathology revealed. The pylorus was negative, the duodenum swung to the right, and the first portion turned downward. The stomach was poor in tone, and emptied in 6 hours. Roentgen Examination.-Roentgenographically, we found that the gall bladder filled and emptied well. She was especially tender over the right abdomen, but no mass was palpable. Present Condition.-The patient was a tall, flabby looking woman, whose average weight was 128 pounds. Six or seven years before she was referred to us, she began to have pain in the right side of the abdomen, gas, constipation, pain and indigestion associated with meals. She also had had an operation for some uterine disorder. Two years after the appendectomy she passed some kidney stones, had a bladder infection, and was operated upon for a kidney suspension. Previous History.-She had had an appendectomy twenty-five years previous to the present examination. She complained of pain in the right upper quadrant, and was annoyed by gas and constipation.
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W., white, widow, aged 57 years, was referred to us for gastro-intestinal examination, in February, 1930. Most authors agree that the therapy should follow the same lines as that for visceroptosis, and that surgical relief is to be considered only as a last resort. There have perhaps been three cases analogous to ours which have been reported since 1920. Just (2) reports three more cases, one permanent and two temporary. Two were reported by Trémolières and Pierron (7), but neither one was diagnosed until operation. A review of the literature since that date has revealed only a few more such cases. At that time, only one other case could be found. In 1920, Swezey and Black (6) reported a similar case which was detected by one of us in the diagnosis of routine chest roentgenograms. The condition was first described roentgenographically in 1899 by Béclère (4), and quoted by Trémolières and Pierron (7) and Just (2), but Curschmann (5) described it fully in 1894 in his classic monograph on the subject. The etiology is to be found in defective embryological development (2). Whether the condition is due to increased length and consequent overlapping or just to malposition, it is undoubtedly anomalous. There is a type of redundant colon which shows this same interposition of the colon between the diaphragm and the liver, and which may be permanent or temporary (2, 3). The one which we wish to present is of a kind recognized by various names, but most descriptively termed (by the Continental authors) “hepato-diaphragmatic interposition of the colon” (1, 2, and 7).
![blunt injury to the hepatic flexture blunt injury to the hepatic flexture](https://image.slidesharecdn.com/vascular-131023065343-phpapp01/95/vascular-40-638.jpg)
Anomalies of the hepatic flexure of the colon are not as common as the wealth of literature on the subject would lead one to expect.