Delayed Small-intestinal Perforation Caused by Blunt Abdominal Trauma : A Case Report

[ABSTRACT] Delayed intestinal perforation after trauma is rare but can be overlooked without follow-up. We report a case of delayed intestinal perforation after abdominal trauma in a 45-year-old man, who was successfully treated without complications. The previously healthy patient had severe lower abdominal pain because of a single-bicycle accident and was brought to the Kawaguchi Municipal Medical Center. An initial contrast-enhanced computed tomographic examination showed no abdominal hematoma or free air but did show mild ascites in the pelvis. The physical and laboratory findings suggested a low possibility of peritonitis. However, the patient was admitted to our hospital for observation. The next day, an X-ray examination of the chest showed free air under the right side of the diaphragm. Furthermore, a second contrast-enhanced computed tomographic examination showed free air and an edematous intestinal wall with abscess around the terminal ileum. Therefore, emergent laparotomy was performed and revealed a perforated thickened ileum with an abscess in the right lower abdomen. Partial resection of the small intestine was performed. The patient was discharged without complications, such as paralytic ileus, on postoperative day 13. Delayed intestinal perforation should be considered after blunt abdominal trauma, even if a patient does not present with peritonitis.