Delayed Small Bowel Perforation with Findings of Severe Ischemia Following Blunt Abdominal Trauma

BACKGROUND: Isolated small bowel perforation following blunt abdominal trauma (BAT) is an uncommon situation with high morbidity and mortality rates, and delayed small bowel perforation is even rarer. The pathophysiology of this condition is not clear in all cases. To the best of our knowledge, this is the first case report of delayed small bowel perforation following BAT with extensive portomesenteric vein gas. CASE REPORT: A 33-year-old male patient was admitted to the emergency department after a car accident. His initial abdominal CT showed no signs of posstraumatic injury. However, follow-up CT, performed after deterioration in his general condition, showed jejunal dilatation, intestinal intramural gas, portomesenteric vein gas, extensive intraperitoneal gas and intraabdominal free fluid. CT findings and emergent laparotomy findings were both compatible with small bowel ischemia-necrosis and perforation. CONCLUSIONS: Delayed small bowel perforation following BAT is thought to occur secondary to mesenteric hematoma formation or mesenteric tear complications. Our patient did not have any mesenteric injury or hematoma on initial abdominal CT. We are not aware of any other case report of delayed small bowel perforation following BAT without signs of intraabdominal injury on initial imaging and extensive portomesenteric vein gas on follow-up imaging. Ischemic bowel necrosis was the main cause of portomesenteric vein gas in our case. Posttraumatic patients should be kept under medical observation and abdominal CT should be preferred for imaging in case of a deterioration in the general condition and laboratory findings or appearance of new abdominal complaints.