Jejunal transection following trivial trauma: Case report and review of literature

Jejunal perforation after a trivial trauma: A case report

Jejunal perforation after a trivial trauma is a rare event. We present a case of a 23-year-old man, a truck driver who suffered jejunal perforation following a jump from the Indian jumbo truck, approximately 2 m height from the ground. This case report highlights the importance of careful evaluation of a symptomatic patient after a trivial injury, and the challenges faced by surgeons in the low recourse-setting.

Complete Jejunal Transection After Blunt Abdominal Trauma: A Case Report

INTRODUCTION

Isolated complete transection of the small bowel is extremely rare in blunt abdominal trauma. If it occurs, it is often associated with high-energy impact, as seen in motor vehicle accidents and falls from heights. In this case, a trivial trauma due to a handlebar injury caused a complete transection of the middle jejunum.

CASE PRESENTATION

A 47-year-old man walked into the emergency department with moderate abdominal pain ∼10 hours after a fall on to a bicycle's handlebar from a standing position. A bedside ultrasound showed minimal amount of free fluid and a following performed computed tomographic scan indicated an edematous loop of small bowel with diminutive amount of extraluminal air, suggesting small bowel perforation. Because of the absence of abdominal peritonism in a hemodynamically stable patient, a conservative treatment and surveillance was established. In the follow-up, the patient suddenly developed severe abdominal pain with now clear signs of peritonism. An emergency laparoscopy showed a complete transection of the middle jejunum. A primary anastomosis was performed. The patient had an uneventful recovery and was discharged after 7 days.

CONCLUSIONS

Even seemingly trivial blunt abdominal traumas can cause complete transection of the small bowel, as shown in this case. Patients with blunt abdominal trauma need to be reviewed frequently by an experienced clinician. Diagnostic laparoscopy attaches a great importance to early detection and treatment of small bowel injuries. The mechanical pattern of the injury seems to be more important than the energy of the impact itself.