Peritonitis following traumatic small bowel perforation

Case contributed by Ammar Haouimi

Presentation

Hit by a car 5 days ago. Presented with signs of acute abdomen with high grade fever.

Patient Data

Age: 20 years
Gender: Male

The CT scan demonstrates:

  • small bowel perforation of the distal ileum (diameter = 10 mm), located 15 mm from the ileocecal valve 
  • thickened and enhanced wall of the small bowel loops
  • intraperitoneal effusion with free gas in the peritoneal cavity. (hydropneumoperitoneum)
  • mesenteric fat stranding with thickening and enhancement of the peritoneal reflections
  • left lung base atelectasis

Annotated image:

  • red arrow indicates the site of the ileal perforation
  • yellow arrow indicates the hydropneumoperitoneum

 

Case Discussion

CT features most consistent with peritonitis following traumatic small bowel perforation, which was confirmed at surgery. Unfortunately, the patient died less than 24h after surgery.

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