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Multiple isolated small bowel perforations following blunt abdominal trauma

2018; Elsevier BV; Volume: 53; Linguagem: Inglês

10.1016/j.ijscr.2018.10.023

2210-2612

João Louro, Miguel Nico Albano, Teresa Vieira Caroço, Luís Reis, Carlos Costa Almeida,

Pelvic and Acetabular Injuries

Small bowel injury is uncommon after blunt abdominal trauma. Repeated clinical assessment is important, especially when investigative imaging is negative.39-year-old male presented to the emergency department following a blunt abdominal trauma. No initial hemodynamic abnormalities were found. Abdominal CT scan was negative for small bowel perforation. Repeated clinical assessment revealed increasing abdominal pain with tachycardia, and an emergent laparotomy was undertaken. Four grade II and one grade I small bowel perforations were found, all repaired with interrupted sutures. Patient was discharged home on day 7.The diagnosis of small bowel injury is difficult and a low threshold of suspicion is crucial to reduce morbidity and mortality. Hemodynamic instability or abdominal tenderness after blunt abdominal trauma are indications for immediate surgical exploration, despite negative imaging findings. Serial clinical assessment is the main decision tool to perform an abdominal exploration.