Isolated Jejunal Perforation after Minor Blunt Abdominal Trauma

Excerpt

To the Editor: A 9-y-old boy presented to our emergency department with abdominal pain and vomiting for one day after sustaining abdominal trauma. The boy had fallen over while running on the street and had landed flat on his abdomen the previous evening. He had developed sudden abdominal pain and was taken to a local hospital where he was observed overnight, found to have no abnormality and discharged the next morning. On going home, his abdominal pain worsened and he was brought to our hospital. On examination, he was afebrile, pulse rate was 98/min with low volume, respiratory rate 28/min, blood pressure 80/60 mmHg. The abdomen did not show any visible marks of trauma, there was generalised tenderness, guarding and absent bowel sounds. He was resuscitated with normal saline boluses till he was hemodynamically stable and given intravenous antibiotics. Investigations showed hemoglobin 15.6 g/dL, total leucocyte count 2.2 × 10⁹/L, platelet count 3.23 × 10⁹/L, blood urea 60 mg/dL, creatinine 0.9 mg/dL, SGOT 74 U/L, SGPT 20 U/L, normal electrolytes, blood glucose 82 mg/dL and amylase 225 U/L (normal range 28–100). The upright abdominal X-ray did not reveal free air under diaphragm. Ultrasound abdomen revealed free fluid in the peritoneal cavity. On Contrast Enhanced Computed Tomography (CECT) of the abdomen, there was pneumoperitoneum with free fluid (Fig. 1). Exploratory laparotomy demonstrated a solitary 6 cm long full thickness jejunal tear, 2 ft distal to the duodeno-jejunal flexure on the antimesentric border. The edges were freshened and sutured. He was discharged uneventfully from the hospital on the tenth day.

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