Bowel and pancreatic injuries are occasionally missed in imaging studies of abdominal trauma despite their critical sequelae. This case is an example of how occasionally it is difficult to detect a bowel injury in a CT study. Here are some helpful tips:

• assessment of parenchymatous organ injury should not distract attention from potential bowel and pancreatic injuries
• a careful search for a pneumoperitoneum should be done
• even a minimal amount of pneumoperitoneum could be significant and requiring immediate surgery or at least close imaging follow up
• lung window is helpful in the detection of pneumoperitoneum
• in isolated traumatic small bowel injuries, the patient is usually vitally stable and complaining from abdominal pain only with a very low clinical suspicious about his injury

Intraoperative image contribution by the surgeon Dr Adel Abdelwahed