Katwal S, Ghimire A, Joshi N. Uncommon presentation: isolated small bowel perforation after blunt abdominal trauma in a pediatric patient; a case report.
Ann Med Surg (Lond) 2023;
85:6222-6226. [PMID:
38098590 PMCID:
PMC10718358 DOI:
10.1097/ms9.0000000000001421]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance
A small bowel perforation occurring in isolation as a result of blunt abdominal trauma (BAT) is a rare event, especially in pediatric patients. The unusual presentation and lack of distinct clinical indications can pose a challenge in promptly diagnosing this condition. This study seeks to underscore the importance of early detection and immediate surgical intervention when dealing with small bowel perforations following BAT.
Case presentation
A 13-year-old girl arrived at the emergency department after falling from a cliff. Initial evaluations, including a physical examination and imaging studies, did not uncover any notable irregularities. Nevertheless, the persistent abdominal discomfort and pain prompted further concerns. A contrast-enhanced computed tomography scan was performed, confirming ileal perforation. The patient subsequently underwent exploratory laparotomy, which resulted in successful surgical treatment.
Clinical discussion
BAT causes increased intraluminal pressure, leading to blowout perforation of the small bowel. Diagnosis can be challenging, particularly in the absence of immediate symptoms or conclusive radiographic findings. Close observation and repeated examinations are essential to detect delayed perforations. Early surgical intervention within 12 h of injury has been shown to significantly reduce complications and mortality rates.
Conclusion
Isolated small bowel perforation is a rare occurrence in pediatric patients, and timely diagnosis and surgical intervention are crucial for favorable outcomes. Diagnostic imaging, like contrast-enhanced computerized tomography, helps identify the condition when clinical findings are inconclusive. Comprehensive counseling is essential for patients and their families to understand potential risks and intervention needs, ensuring appropriate management, and treatment delays.
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