Traumatic small bowel perforation

Case contributed by Dr Ian Bickle

Presentation

Construction worker. Metal bar fell on abdomen 10 days prior. Initial CT reported to be normal. Now peritonitic.

Patient Data

Age: 30
Gender: Male

12 cm gas and fluid filled walled off collection in the midline of the abdomen largely occupying the small bowel mesentery. Suspicion of occasional bleb of intraperitoneal gas adjacent to the collection. Dilated fluid-filled small bowel distally in the pelvis

Small volume pelvic free fluid.

Small bowel loops laterally in the left side of the abdomen indicating a element of malrotation.

The solid organs normal.  Normal large bowel.

Comment: Enlarged intra-abdominal fluid collection, appears related to the mesentery and small bowel.

Photo

Intra-operative notes confirming the suspicion on CT, as well as the operative management.

Case Discussion

Appearance is highly suggestive of small bowel injury.  Blunt trauma to the abdomen is often the cause.

A few points of interest in this case:

1.  Movement artifact (sometimes unavoidable) can contribute to challenge in image interpretation.

2.  Abdominal injuries can present in a delayed fashion. Always review prior imaging.

3. Its teamwork - direct your clinician towards what you think is wrong, not just in image reporting, but opinion.

4.  Never say never - it will come back to bite you one day!.

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Case information

rID: 47152
Case created: 2nd Aug 2016
Last edited: 14th Aug 2016
Inclusion in quiz mode: Included

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