Small bowel perforation following blunt abdominal trauma caused by an accidental hammer blow: A case report

Abstract

Introduction. Trauma is among the leading causes of death. Undetected and untreated adequately and on time, traumatic small bowel injuries can be lethal. Case Report. We present a case of a small bowel perforation after a blunt abdominal injury, caused by an accidental self-inflicted hammer blow to the abdomen. The initial abdominal and chest x-rays and abdominal ultrasound did not indicate an injury to the abdominal organs. Due to the impaired clinical picture and the fact that the patient was hemodynamically stable, multi-detector computed tomography of the abdomen and small pelvis was performed, showing intraperitoneal free fluid and pneumoperitoneum, not seen by other imaging methods. A decision for surgical treatment was made. The intraoperative finding confirmed a small bowel perforation. Conclusion. Due to the possible false-negative imaging findings, clinical follow-up of patients with abdominal trauma is mandatory when making the decision for surgical treatment.

Extraordinarily Rare Isolated Intraperitoneal Urinary Bladder Rupture in Blunt Abdominal Injury Without Pelvic Fracture: An Aide-Mémoire

“…Blunt abdominal injuries, in the 3rd place, right after head and chest traumas can cause injury to both the solid organs, mostly the liver and spleen, and the intestines. Because of its anatomical location in the pelvis, the bladder is well protected against external forces, injuries which represent only up to 2% of all blunt abdominal trauma cases [5].…”

“…Herein, a free fluid on the abdominal US after abdominal trauma represents a positive finding but is unreliable in distinguishing types of free fluid like urine, blood, etc. The method of choice in the diagnosis of blunt abdominal trauma is CT, which allows the detection of both parenchymal and hollow organ injury, in hemodynamically stable cases [5]. Non-contrast CT scans can identify simple fluid ascites but often cannot identify a laceration on the bladder itself.…”

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

“…These almost non-specific findings on US should be properly interpreted in trauma because they can lead to the diagnosis if there is a clinical suspicion. CT is the most reliable method for detection of small bowel perforation (sensitivity 92%, specificity 94%) [7,15,16,17]. Recent systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in most clinical situations [18].…”

“…Recent systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in most clinical situations [18]. Small bowel perforation on CT is evident in the presence of direct signs such as bowel wall discontinuity, extraluminal air or presence of extraluminal contrast, or indirect CT sings: bowel wall thickening, abnormal bowel wall enhancement, presence of abdominal abscess formations [7,15,16,17] or mesenteric fat stranding and a moderate to large volume of unexplained intraperitoneal fluid in the absence of solid organ injury [19]. CT signs that correlated with mesenteric laceration are abdominal wall injury, mesenteric contusion, free fluid in peritoneal cavity, segmental bowel hypoenhancement, and bowel hyperenhancement adjacent to a hypoenhancing segment [20].…”