AB202. SOH26AB_0126. Delayed jejunal transection following blunt abdominal trauma from a road traffic accident: a case report

Background: Blunt abdominal trauma from road traffic accidents can result in occult small bowel injuries that may not be apparent on initial imaging. Delayed perforation is associated with significant morbidity. Patients with seatbelt-related abdominal wall bruising are at particular risk, and computed tomography (CT) may initially demonstrate only non-specific findings such as bowel wall oedema. Early identification and timely intervention are essential for preventing deterioration. Clinical, radiological, and operative data from the patient’s initial admission, subsequent re-presentation, and definitive management were reviewed. The sequence of diagnostic assessments, imaging interpretation, intraoperative findings, and postoperative complications was analysed to identify factors contributing to delayed recognition of jejunal injury following blunt abdominal trauma.

Case Description: A 31-year-old male involved in a road traffic accident had initial CT findings limited to jejunal oedema, with no evidence of perforation. He remained clinically stable and was discharged after 48 hours of observation. Seven days later, he re-presented with tachycardia, abdominal tenderness, leukocytosis (white cell count 21.3×10⁹/L), and markedly elevated C-reactive protein (322 mg/L). Repeat CT demonstrated pneumoperitoneum and multiple intra-abdominal collections. Emergency laparotomy revealed a near-complete jejunal transection 20 cm distal to the duodenojejunal flexure with faecal peritonitis. Resection and primary anastomosis were performed. Postoperatively, the patient developed multiple abscesses requiring percutaneous drainage and prolonged antibiotics, with complete radiological resolution at follow-up.

Conclusions: Small bowel injuries from blunt trauma may evolve over time and can be missed on early CT imaging. Persistent symptoms, abdominal wall bruising, or rising inflammatory markers should prompt repeat imaging and a low threshold for surgical review to avoid delayed perforation and sepsis.

Keywords: Blunt abdominal trauma; computed tomography limitations in trauma (CT limitations in trauma); emergency laparotomy; seatbelt sign injuries; case report