Occasionally, gastroenterologists are asked to assist in the management of patients with blunt abdominal trauma. At least 50% of these patients are injured in motor vehicle accidents and some have skeletal fractures involving the ribs, pelvis or spine. The intraabdominal organs most likely to be damaged are the liver and spleen. Other injuries can involve the kidneys, pancreas, duodenum, bladder and urethra. Injuries to the large bowel are uncommon but may account for 3–5% of all abdominal injuries. These injuries can be categorized as lacerations of the mesentery, intramural hematomas and bowel lacerations with perforation. When intramural hematomas occur as the major abdominal injury, symptoms are variable but include abdominal pain, rectal bleeding and bowel obstruction. These symptoms can occur soon after the injury or may be delayed for up to 1 week. The investigation of choice is a computed tomography (CT) scan. However, helpful information can be obtained by ultrasound or barium enema studies. In case reports, most patients have been treated by surgical drainage or resection. However, conservative management is an option in some settings such as the patient illustrated below.

A 27-year-old man was admitted to hospital because of the development of abdominal pain after an automobile accident. His vital signs were normal but physical examination revealed tenderness over the right upper abdomen. Various blood tests were within the reference range. An abdominal CT scan showed a soft tissue mass, 5 cm in diameter, in the right abdomen that was close to the liver and right kidney (Figure 1). The abnormality was consistent with an intramural hematoma of the ascending colon. No other abnormalities were detected. A barium enema study showed circumferential narrowing of the ascending colon that mimicked an annular neoplasm (Figure 2). As he remained stable, he was observed without surgery. Serial ultrasound studies showed that the diameter of the hematoma decreased to 4.5 cm, 4.0 cm and 2.5 cm at 1, 2 and 4 weeks after presentation, respectively. Ultrasound studies were normal at 3 months. Intramural hematomas after blunt abdominal trauma can be managed conservatively in at least some stable patients.