Two Cases of Near-Missed Intestinal Perforation at the Initial Survey of Trauma Patients

Abstract

Untreated intestinal perforation sustained following a blunt trauma mostly results in generalized peritonitis, ultimately leading to sepsis. Most cases warrant surgical repair. Thus, any signs and symptoms of intestinal perforation should be crucially detected, and a general surgeon should be immediately consulted. These signs include abdominal tenderness, abdominal distention, fever, and leukocytosis. With the advent of computed tomography (CT) scans, the detection rate of perforation improved. However, the signs and scans remain non-definitive in some cases. Here, we present two cases of near-missed intestinal perforation: one case was clearly suspected of intestinal perforation, whereas the other was not so apparent. First case A 55-year-old male presented to the emergency room (ER) after sustaining a fall from an approximately 3-m-high site with complaints of severe abdominal pain. His vital signs were stable. The CT scan revealed an apparent small pneumoperitoneum (Fig. 1). The patient was immediately brought to the operating room (OR) for exploratory laparotomy, which revealed a 2-cm-sized laceration at the antimesenteric border of the proximal jejunum. Minimal bowel content spillage was noted and there were no other internal organ injuries. The laceration was primarily repaired. The patient was discharged on postoperative day 10 without complication.