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Complete Jejunal Transection After Blunt Abdominal Trauma

A Case Report

Kuchen, Natalie MD*; Gmuer, Christian MD; Schoeb, Othmar MD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: February 2019 - Volume 29 - Issue 1 - p e7–e8
doi: 10.1097/SLE.0000000000000583
Online Articles: Technical Reports
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Introduction: Isolated complete transection of the small bowel is extremely rare in blunt abdominal trauma. If it occurs, it is often associated with high-energy impact, as seen in motor vehicle accidents and falls from heights. In this case, a trivial trauma due to a handlebar injury caused a complete transection of the middle jejunum.

Case Presentation: A 47-year-old man walked into the emergency department with moderate abdominal pain ∼10 hours after a fall on to a bicycle’s handlebar from a standing position. A bedside ultrasound showed minimal amount of free fluid and a following performed computed tomographic scan indicated an edematous loop of small bowel with diminutive amount of extraluminal air, suggesting small bowel perforation. Because of the absence of abdominal peritonism in a hemodynamically stable patient, a conservative treatment and surveillance was established. In the follow-up, the patient suddenly developed severe abdominal pain with now clear signs of peritonism. An emergency laparoscopy showed a complete transection of the middle jejunum. A primary anastomosis was performed. The patient had an uneventful recovery and was discharged after 7 days.

Conclusions: Even seemingly trivial blunt abdominal traumas can cause complete transection of the small bowel, as shown in this case. Patients with blunt abdominal trauma need to be reviewed frequently by an experienced clinician. Diagnostic laparoscopy attaches a great importance to early detection and treatment of small bowel injuries. The mechanical pattern of the injury seems to be more important than the energy of the impact itself.

*Centre for Surgery Zurich

Emergency Department, Hirslanden Private Hospital Group, Zurich, Switzerland

The authors declare no conflicts of interest.

Reprints: Othmar Schoeb, MD, Hirslanden Private Hospital Group, Witellikerstrasse 40, Zurich 8032, Switzerland (e-mail: os@professorschoeb.ch).

Received August 9, 2018

Accepted August 17, 2018

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