Traumatic Jejunal hematoma in childhood—A case report and review of literature

INTRODUCTION: Intramural jejunal hematoma is a very rare condition with only few cases reported in the literature. It rarely occurs spontaneously, and is mostly seen in hemophiliac patients and is also associated with abdominal trauma. It occurs more commonly in children than in adults and can present with features of intestinal obstruction. CASE PRESENTATION: A 10 year old boy presented with features of intestinal obstruction. He sustained a blunt abdominal trauma two days prior to presentation. Abdominal computed tomography (CT) revealed jejunal hematoma with signs of complete obstruction. A trial of non-operative management failed and eventually he was managed surgically. DISCUSSION: Blunt trauma to the abdomen is the principle cause of jejunal hematoma. The trauma in majority of cases is trivial and usually the patients present late. The symptoms range from mild abdominal pain to intestinal obstruction with acute abdomen. A trial of conservative management is justifiable in stable patient. If no clinical improvement surgical intervention is indicated. CONCLUSION: Intramural jejunal hematoma after blunt abdominal trauma is seen predominately in pediatric age group and can present as intestinal obstruction. It should be suspected when a child presents with intestinal obstruction and a concurrent history of blunt abdominal trauma. The mainstay of treatment is surgical intervention. Because of the rarity of this disease, the role of conservative therapy is undefined.