A three-year-old female child was admitted to emergency department with a history of accidental fall from six-feet height to ground one day before. According to the parents, the child was asymptomatic initially. She started complaining of pain all over abdomen after four hours of fall, which was generalised in nature. She started vomiting approximately eight hours after initial trauma, which was greenish in colour and non-projectile. There was no history of loss of consciousness, Ear, Nose and Throat (ENT) bleed, haematemesis or melaena.The child was then taken to the nearest doctor who advised ultrasonography of abdomen and pelvis which revealed diffusely oedematous jejunal loops, minimal ascites with internal septation due to duodenal or jejunal perforation. There were signs of generalised peritonitis.On admission to our hospital, 24 hours post trauma, patient was febrile and she looked toxic with signs of dehydration. Physical examination revealed pulse-134 beats/min and blood pressure was 86/66 mmHg. No bruises or other external injuries were noted. Abdominal examination revealed distension of abdomen with tenderness and guarding all over the abdomen. Shifting dullness was present and bowel sounds were absent. Routine blood investigations were done which were within normal limits other than raised total leucocyte count which was 13600/mm 3 and decreased serum sodium which was 130 mmol/lit. Erect X-Ray abdomen showed gas under the diaphragm [Table /Fig-1]. Repeat ultrasonography and Computed Tomography (CT) abdomen was not done due to frank clinical diagnosis and considering the duration of trauma.Patient was planned for emergency explorative laparotomy. Right upper transverse incision was taken considering the age of patient. On exploration abdomen was found to be filled with bilious fluid. There was a single isolated jejunal perforation of size 3×2 cm at antimesenteric border, about 100 cm away from the ligament of Treitz [Table/ Fig-2]. Jejunal loop of 15 cm was found to be gangrenous [Table /Fig-3]. The rest of the bowel and other organs were normal.Resection of gangrenous segment of jejunum and jejuno-jejunostomy was done. Drains were inserted and the abdomen was closed after thorough saline wash. Patient was started on antibiotics as per routine protocol. Postoperatively, drain was removed on fifth day and all sutures were removed on eighth day. The postoperative course was uneventful and the patient was discharged after 10 days.
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