Traumatic Decompression of the Jejunum: A Case of Small Bowel Perforation From High-Speed Motor Vehicle Crash

Abstract

We present a rare case of a focal perforation of the jejunum after a high-speed motor vehicle crash. A 60-year-old restrained rear seat passenger presented with severe abdominal pain. She was hemodynamically stable and underwent the traditional trauma workup. CT scan of the abdomen showed large-volume free intraperitoneal air and L4/L5 compression fractures. Given the peritoneal physical exam finding and free air on CT scan she was taken emergently to the operating room. Operative exploration revealed free intraperitoneal air upon entry into the abdominal cavity as well as murky fluid throughout the mid abdomen. A focal perforation was discovered on the antimesenteric surface of a segment of jejunum. The perforation was repaired primarily in two layers and the abdomen was closed. Postoperative course was uncomplicated. Antibiotics were continued for 4 days. Focal perforation of the small bowel from high-speed blunt trauma is a rare isolated injury. Close attention to physical exam and radiologic findings allows for early diagnosis and treatment of these injuries.