Presentation
Abdominal pain following blunt abdominal trauma due to a traffic accident.
Patient Data
Scattered pneumoperitoneum is observed, predominantly in the prehepatic region.
Thickened walls of the ileum and ascending colon are observed in the right hypochondrium, showing marked post-contrast enhancement, with associated mesenteric edema and hyperemia. A few free air pockets are noted adjacent to the bowel.
Mild free fluid is seen in the abdominal cavity, predominantly in the pelvic region.
No abnormalities are observed in other abdominal organs.
Surgical report:
The abdominal cavity was clean, with a small amount of fibrinous exudate and digestive fluid in the right abdomen, near the ascending colon. No fluid or blood was observed in other areas.
A segment of the small intestine (jejunum), approximately 60 cm distal to the Treitz ligament, was perforated with a 1 cm defect, leaking digestive fluid. Several adjacent small bowel loops showed seromuscular tears.
The ascending colon was naturally adhered to the abdominal wall and showed bruising over a segment of approximately 3 cm. The seromuscular layer remained intact, with no evidence of digestive fluid leakage.
Other segments of the colon and small intestine were intact. Other abdominal organs were normal.
Case Discussion
The imaging and intraoperative findings are consistent with a small bowel perforation. Postoperatively, the patient's clinical symptoms improved, blood tests were within normal limits, and the patient was subsequently discharged.
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