The 3 male patients were 27, 36 and 42 years old, respectively (average age of 35 years). They were trapped inside collapsed structures for 22, 21 and 37 h, respectively (average time of 26.3 h). They were admitted into our hospital at 37, 44 and 39 h, respectively, after trapped in the buildings. Their primary earthquake-related traumatic injuries mainly occurred on the head and extremities, including 1 case with a left thorax crush injury. The physician specialists in various departments of our hospital consulted and discussed the cases with experts from The Liberation Army General Hospital of Beijing immediately after the patients’ admission. Treatment plans were designed individually by a multi-disciplinary team. The patients underwent 4, 3 and 3 surgeries, respectively, according to their clinical features. The final operation for each patient, which was a small bowel resection, was performed on postoperative days 38, 21 and 10, respectively. Antibiotic therapy, intravenous fluid hydration, mechanical ventilation and intermittent hemodialysis were administered to all 3 patients after admission.
Representative case report
A 27-year-old healthy male patient with a relatively healthy medical history had multiple body injuries due to high-force impacts from a building collapse in the Wenchuan earthquake on May 12, 2008. He was rescued after being trapped in building debris for 22 h. He was admitted to our hospital on May 14. He remained conscious and presented with multiple contusions on the head and both lower extremities at the time of admission. Neither of his legs could be moved freely, and both were significantly swollen. The pulse of the bilateral dorsalis pedis was absent. The patient’s toes presented as dark purple with poor blood circulation. A physical examination showed no signs of abdominal trauma. At the time of admission, emergency decompression surgery was performed on the osteofascial compartment of the left lower extremities under local anesthesia. We suspected that the patient had acute renal failure due to a lack of urination, and hemodialysis was administrated. On May 16, the patient underwent emergency amputation of both legs at the mid-thigh. On May 20, the patient experienced abdominal distension with diarrhea; blood appeared in a stool sample. On May 24, the patient developed worse abdominal distention, mild tenderness around the belly button and no rebound tenderness or muscle tension. Bowel sounds were absent. An ultrasound test revealed intestinal expansion and a small amount of peritoneal fluid. On May 26, jejunum drainage was placed under gastroscopy. The drainage output was 1000 mL, and the abdominal distension was significantly relieved. On May 30, the patient developed infections in right lower extremitie. A second amputation operation was performed on his right thigh. On June 3, thoracentesis was performed on his left chest cavity due to significantly increased pleural effusion. On June 7, the patient developed dark bloody stool that occurred 3-4 times per day. The patient’s urine output gradually returned to normal by intermittent hemodialysis. On June 19, the patient developed worsening abdominal pain and tenderness, and a mass was noted around the middle and lower abdomen. Peritoneal irritation was obviously present. On emergency abdominal exploration (Figure ), significant intestinal adhesion was noted. The intestine approximately 210 cm below the Treitz ligament and 50 cm above the ileocecal valve was expanded, thickened and twisted into a mass, with a large amount of inflammatory exudate. Intestinal adhesion, necrosis and perforation with fistula were noted (Figure ). The proximal jejunum was expanded and thickening. The patient underwent small bowel resection, which revealed scattered erosion with hemorrhage in the intestinal mucosa. The postoperative pathology report included hemorrhagic enteritis and intestinal adhesion with fistula formation (Figure ). The patient experienced dark bloody or tarry stools 2 wk after surgery (approximately 200-800 g/d). Antihemorrhagic, antacid therapy and nutritional support were administrated. Eventually, the patient was discharged and made a full recovery.
Anesthesia was administrated to the patient who underwent amputation of the bilateral extremities. The surgical area was sterilized in preparation for the operation.
The damaged small intestine was adhered into a mass with a fistula. Thickness and hyperplasia were noted on the small intestinal wall after the part of damaged intestine was cleaned.
Large necrotic lesions along with macrophage infiltration were observed in the intestinal mucosa. Collagen fiber hyperplasia was also present on the submucosal membrane.