Post-earthquake delayed bowel perforations in multi-trauma patients: Insights from the 2023 Türkiye earthquakes

Intestinal perforation may occur, albeit rarely, following blunt abdominal trauma. However, there is insufficient data in the literature regarding late-onset intestinal ischemia and perforation observed during hospitalization in patients rescued from under the rubble after earthquakes. The intestinal perforations that occurred in this patient group were defined as 'stress-related intestinal ischemia.' After the two earthquakes measuring 7.8 and 7.5 on the Moment Magnitude Scale that occurred in Türkiye on February 6, 2023, a total of 1261 patients were treated at our hospital. Among these patients, delayed intestinal perforation developed in three cases (0.23%) during their hospitalization for various reasons. Two of the patients had a history of hemodialysis due to acute kidney injury, while one patient had undergone continuous renal replacement therapy. No mesenteric injury was detected in any patient, and the median time between the earthquake and the development of intestinal perforation was 30 days. Two patients underwent small bowel resection and anastomosis, while the other patient underwent subtotal colectomy with end colostomy. The median length of stay in the general surgery ward following abdominal surgery was 12 days, and the median total hospital stay for treatment was 67 days. All patients were successfully discharged after completion of their postoperative treatment. In conclusion, delayed intestinal perforations may occur in multi-trauma patients after earthquakes, especially in those with risk factors such as hemodialysis, major surgeries, and prolonged hospitalizations. Stress-induced intestinal necrosis should be considered in the differential diagnosis of acute abdominal conditions that may develop during extended hospital stays.