Complaint Of Acute Abdominal Pain Research Articles

017. Etiology of Acute Appendicitis in Paediatric Patients: A Literature Review

Background: Appendicitis is a disease that can occur at any age. The incidence of appendicitis is 1.66 per 1000 children annually. 1-8% of patients who enter the paediatric emergency room with complaints of acute abdominal pain were acute appendicitis patients, and often requires surgery. The etiology and pathogenesis of appendicitis remains unclear despite the treatment of acute appendicitis is patent, some literature says that the etiology of appendicitis was multifactorial. Methods: A literature search was conducted using online database sites namely Cochrane, PubMed, EMBASE, and Proquest. Results: Literature searches on Cochrane, PubMed, EMBASE, and ProQuest database sites obtained 2,719 articles, 30 articles met the criteria. Among them, the etiology of acute appendicitis in paediatric patients was caused by obstruction of the appendiceal lumen because of appendiceal intraluminal fecalith, lymphoid hyperplasia, viral or bacterial infection, parasites, foreign bodies and tumors. Conclusion: The etiology of acute appendicitis in paediatric patients was caused by obstruction of the appendiceal lumen, most of the obstruction was caused by lymphoid hyperplasia whether accompanied by the presence of appendiceal intraluminal fecalith or not. Other etiologies such as obstruction due to parasites, foreign bodies and tumors.

Perforated Meckel’s Diverticulum: A Case Report

Meckel’s diverticulum is a true diverticulum that consists of all layers of bowel normally found in a normal small bowel wall. The three most common presentations in children are intestinal bleeding (30–56%), intestinal obstruction (14–42%), and diverticular inflammation (6–14%). Complications result in more severe symptoms, such as acute abdomen and signs of peritonitis. These presentations are not specific to Meckel’s diverticulum and can be found in many other conditions, making the diagnosis difficult. A five-year-old child came to the emergency department with complaint of acute abdominal pain, especially in the right lower quadrant. The pain was accompanied by vomiting. On physical examination, patient was febrile and signs of peritonitis were found. Abdominal plain film revealed the probability of focal inflammation in the right lower region of the abdomen, with partial intestinal obstruction. Ultrasonography showed a presence of a mass in right iliac region with the size of 24x20x23 mm, with normal appendix. During exploratory laparotomy, a necrotic and perforated Meckel’s diverticulum was found, with associated purulent matter. Diverticulectomy with segmental resection of ileum followed by end-to-end anastomosis were done. Diagnosis of Meckel’s diverticulum requires a high index of suspicion, especially in the pediatric population. It is important for clinicians to be aware of unusual presentations of Meckel’s diverticulum.

Catamenial Pneumothorax: An Unusual Cause of Abdominal Pain.

A catamenial pneumothorax is a very rare condition resulting in spontaneous and recurrent pneumothoraces that occur in relationship with menses (T. Marjański et al., 2016). Although rare, emergency providers should consider this condition when female patients present to the emergency department with chest discomfort and dyspnea during menstruation. This case describes a patient who presented to the emergency department with abdominal pain who was incidentally found to have a catamenial pneumothorax on diagnostic imaging for her complaint of acute abdominal pain.

The prognostic values of platelet to lymphocyte ratio for predicting mortality in patients with acute mesenteric ischemia: a cross-sectional study

Introduction: Acute mesenteric ischemia (AMI) is a life-threatening disease that can cause multi-organ damage and ultimately lead to death. Early diagnosis and treatment significantly reduce morbidity and mortality rates in high-risk patients. This study aimed to explore the prognostic values of platelet to lymphocyte ratio (PLR) in predicting mortality in patients with mesenteric ischemia. Methods: This prospective study included 126 patients with a complaint of acute abdominal pain, suggesting mesenteric ischemia. Demographic data and measured variables were determined using a pre-designed questionnaire. Statistical analysis was conducted using t test analysis, Spearman correlation analysis, and receiver operating characteristic (ROC) curve. Results: Of 126 studied cases, mesenteric ischemia was confirmed in 47 patients. The mean age in patients with mesenteric ischemia (68 years) was significantly higher than that of non-ischemic patients (65 years). Mean blood bicarbonate level in non-ischemic patients (13.53 mmol/L) was higher than ischemic patients (11.15 mmol/L) (P<0.0001). PLR in patients with mesenteric ischemia and non-ischemic patients was 159 and 151, respectively; this difference was not statistically significant (P=0.14). The overall mortality rate in this study was 61%. Conclusion: Even though the PLR increases in patients with systemic inflammation, it cannot distinguish between patients with mesenteric ischemia and other inflammatory conditions.

P7.01: Selecting Candidates for Multi-Visceral Transplantation in Neuroendocrine Tumors (NET) of the Gastrointestinal Tract: A Review of Two Cases

Introduction: Neuroendocrine tumors (NETs) are rare neoplasms arising neurologic or endocrine tissues. These tumors can be seen in nearly any organ system, though they mostly would be present in the gastrointestinal and respiratory systems. In this study, we report two cases of multi-visceral transplantations (MVT) in NET and discuss our indications for MVT among NET patients. Methods and Results: Case 1: A 44-year-old lady referred with a complaint of acute abdominal pain and small bowel obstruction symptoms in June 2018. In laparotomy, an obstructive jejunal mass, a huge retroperitoneal lesion involving the mesentery and liver, was found. A partial resection of the jejunal mass and palliative anastomosis of the bowel was performed. Histopathologic examinations revealed a well-differentiated NET [G1 (ki67:1%)]. The patient underwent MVT. She developed an entero-cutaneous fistula ten days after the surgery which was managed. After which the patient was relatively well till February 2021, when she was admitted with severe watery diarrhea. Severe mucosal ulcerations were seen in endoscopy, and rejection was confirmed through pathologic assessments. The patient died despite our efforts. Case 2: A 46-year-old man who had been suffering from vague abdominal pain and dyspepsia was referred to our clinic in February 2021. He gave a history of 5 kilograms weight loss in the preceding six months. Computed tomography (CT) showed a large lobulated heterogeneously enhancing mass about 150*90 mm in the pancreas with extension to the liver hilum and involvement of spleen and stomach, and signs of partial port vein thrombosis. The pathologist reported a well-differentiated NET (G2, ki67<15%, mitosis 1-2/10 HPF). Exploratory laparotomy, performed in May 2021, showed locally advanced pancreatic NET with celiac encasement and involvement of stomach and colon and portal vein thrombosis with varicose veins and portal hypertension, but no evidence of hepatic metastases. MVT was performed in June 2021. The grafts, including stomach, duodenum, liver, pancreas, and small bowel, were implanted. One month later, the patient complained of diarrhea, 3rd-grade acute T-cell rejection, in a small bowl biopsy was reported. However, the liver biopsy was insignificant. Favorably the patient responded well to the treatment, and after six months, closure of ostomy was performed. The patient is alive and well to this day. Conclusion: We propose the following criteria for MVTx in NETs: Well-differentiated NETs; absence of progression in the last six months; extensive porto-mesenteric thrombosis; intestinal failure with liver metastases; Both superior mesenteric artery and celiac trunk involvement; absence of extra-abdominal involvement that is confirmed by Ga-68 dotatate scan. We should note that this was a case report and larger series are required to support our conclusion.

EPIPLOIC APPENDAGITIS: AN UNCOMMON CASE OF ACUTE ABDOMINAL PAIN WITH CHARACTERISTIC IMAGING FINDINGS.

Introduction: th th Epiploic appendagitis is an uncommon cause of abdominal pain and is frequently undiagnosed. Obese men in their 4 and 5 decade of life are most affected. It generally mimics other serious causes of acute abdomen and thus the denitive diagnosis relies on cross-sectional imaging primarily computed tomography ndings. Most often the condition is caused due to torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein. Appendices epiploicae are small (0.5-5 cm long), fat lled pouches of peritoneum projecting from the external surface of colon and are supplied by blood vessels that protrude through the bowel wall. They are present commonly over distal colon particularly numerous at the rectosigmoid junction. Case: We are reporting a case of 42 years old male patient, who presented to the surgical OPD at Dr. RPGMC Tanda with chief complaint of acute abdominal pain localized in the left iliac fossa with tenderness in the region. The ultrasonography report was inconclusive and the patient was further evaluated using biochemical investigations and contrast enhanced CT of the abdominopelvic region. The CECT revealed fat dense ovoid shaped lesion in the left iliac fossa with surrounding fat stranding and hyperdense rim suggestive of intraperitoneal focal fat infarction. The condition was managed conservatively with empirical antibiotics and analgesics. Conclusion: Epiploic appendagitis is a self-limiting disease but persistence of symptoms or recurrence requires surgical management with laparoscopic appendage excision. The anatomical and surgical knowledge of epiploic appendagitis is very important to raise awareness about this clinical condition and to manage it appropriately.

Traumatic Uterine and Bladder Rupture due to Instrumental Vaginal Delivery by Vacuum: A Case Report

Uterine rupture is a very rare but critical obstetrical complication that requires prompt diagnosis and treatment. It is a major complication of instrumental delivery due to lack of skilled personnel and inadequate monitoring in the intrapartum period of delivery. Here, authors present a case report of a 30-year-old woman, who presented to the hospital with complaints of acute abdominal pain, per vaginal bleeding and leakage of urine following vacuum assisted vaginal delivery.This led to traumatic postpartum haemorrhage that required further surgical evaluation and management. Retrospective analysis of such cases give us an idea of the problems that still exist with instrumental deliveries and the importance of labour surveillance during the 2nd stage of labour. Traumatic uterine and bladder rupture following vacuum delivery is a preventable cause of postpartum haemorrhage. Timely recognition of the condition can reduce the maternal morbidity and mortality.

Posterior Gastric Perforation – Rare Surgical Emergency: A Case Report

Background: Incidence of perforation on posterior wall of stomach is rare throughout world; its occurrence has not been found till now in literature of central India. diffuse symptoms with delayed presentation to health center and poorly skilled faculty with facilities make a way to raise in total number of deaths associated with posterior gastric perforation.&#x0D; Objective: To report a rare case of posterior gastric perforation at a tertiary health care center in Central India, which would be first to be documented.&#x0D; Case Presentation: A 74-year-old male patient was referred to Department of General Surgery, AVBRH, with chief complaint of acute abdominal pain for two days. He had a history of alcohol consumtion which was stopped 2 years back A moderately distended, distinctly tender abdomen accompanied by guarding, rigidity and excluded bowel sounds was unveiled by abdominal examination. Patient has been resuscitated with intravenous fluids, antibiotics and analgesics. Consequently, an emergency exploratory laparotomy revealed a significant collection of purulent peritoneal fluid, 1x1 cm sized perforation on posterior wall of stomach. Perforation was repaired and thus patient recovered in a satisfactory way.&#x0D; Conclusion: And since posterior gastric perforation is extremely uncommon and expected to worsen, associated with increased morbidity and mortality leading to missed presence, this case report indicates that evaluation of patients with gastric perforation, identify risk factors and ability to repair perforations right away along with resuscitation will greatly enhance clinical outcome.

Drug-Induced Liver Injury Due To Losartan.

Drug-induced liver injury (DILI) is a challenging diagnosis since a wide variety of medicines can cause adverse reactions. Losartan is an angiotensin II receptor antagonist (ARA-II) approved for the treatment of arterial hypertension. The most common adverse effects are fatigue, anaemia, weakness and cough. An increase in transaminases has been reported with less frequency (<2% of cases). Although the mechanism is not fully understood, DILI onset is usually within 1–8 weeks of therapy, and hepatic enzymology usually normalizes 2–4 months after drug suspension. The authors present the case of a 66-year-old male patient with a medical history of arterial hypertension and a prior hospitalization (4 years previously) for drug-induced hepatitis, which, at the time, was attributed to a dietary supplement. Four years later, because of new onset of hypertension, losartan was reintroduced. After 3 weeks, the patient was admitted to the emergency department with complaints of acute abdominal pain associated with asthenia, nausea and increased abdominal volume that had first developed 8 days previously. After exclusion of other causes, DILI associated with losartan was assumed. This is a very rare adverse effect since only seven cases have been described in the literature.LEARNING POINTSToxic hepatitis due to losartan is very rare, despite widespread use of the drug.A high index of suspicion for drug-induced liver injury (DILI) should be maintained while other diagnoses are carefully excluded.Monitoring the use of the offending drug is crucial, since DILI recurrence is associated with worse prognosis.

Effect of triage on physicians’ clinical decision

Objective: To investigate the effect of the use of color codes for patient triage on physicians’ clinical decision. Methods: This prospective study was conducted among female patients aged 18-65 years who visited the emergency department (ED) with complaints of acute abdominal pain. A 3-level of triage system [red (very urgent), yellow (urgent) and green (less urgent)] was used in our ED. All patients were green level. Half of these patients remained at the green level (the green group), and the remaining patients were re-labeled as false yellow (the false yellow group) in the order of ED visits. Ordering tests, consultation requests, intravenous treatment, length of hospital stay, and cost were compared between the two groups of patients. Results: In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group. There was no statistically significant difference between the two groups in age, temperature, systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation (P&gt;0.05). It was observed that more tests (P=0.001), consultations (P&lt;0.001), and intravenous treatment were requested (P&lt;0.001), and the duration of stay in the ED was longer (P&lt;0.001) and cost (P&lt;0.001) was higher in the false yellow group. Conclusions: Triage do affect the decisions of physicians on female patients with acute abdominal pain.

Case Report on Post Operative Case of Exploratory Laparotomy for Ruptured Ectopic Pregnancy with Septicemia

Introduction: Extra uterine pregnancy is a first-trimester pregnancy problem that affects 1.3–2.4 percent of all pregnancies. The key signs of the ectopic pregnancy are abdominal discomfort and vaginal bleeding along with Sharp, dull, or cramping pains may be experienced around 50% of the women who are suffering from ectopic pregnancy. The neglected ectopic pregnancy may results in the fallopian tube can burst, internal abdominal bleeding, shock, and serious blood loss and later complication is septicemia. As a health care professional it’s very important to manage certain complication with medical and surgical management.&#x0D; Main Symptoms and/or Important Clinical Findings: A 20 years old female with post operative case of Exploratory Laparotomy admitted in A.V.B.R.H. on 14/02/2021.with chief complaints of the after undergone certain investigation she has diagnosed as Exploratory Laparotomy with septicemia as post-op complication.&#x0D; The Main Diagnoses, Therapeutic Interventions, and Outcomes: A 20 years old female with post-operative Exploratory Laparotomy for Ruptured Ectopic Pregnancy operated case with septicemia, with chief complaints of acute abdominal pain, and vaginal bleeding the doctors manage her initially with I.V. fluids, antibiotics, Zonac suppository and adequate nursing management.&#x0D; Nursing Perspectives: The nursing interventions initiated for managing present case are fluid replacement therapy, monitoring vital sign per hourly, monitoring the CBC reports and other investigations like USG abdomen, blood glucose levels. Maintained TPR Chart, I/O Charting, abdominal girth charting.&#x0D; Conclusion: In the Present case the patient of A 20 year old female with post operative exploratory laparotomy for ruptured ectopic pregnancy with septicemia it has been managed with the therapeutic and surgical treatment ,right now the patient condition then patient has discharged on dated 22/2/21.

Small bowel perforation secondary to foreign body ingestion mimicking appendicitis: a case report

Admittance in the emergency room with complaints of acute abdominal pain is a common scenario. Patients who see the doctor due to foreign object ingestion present transitory symptomatology. In most cases, foreign object ingestion in adults is accidental, although it may be linked to physiological, anatomical, mechanical, social and psychiatric factors. The frequency of voluntarily ingested objects is higher among children and teenagers than in any other age group. Few people go to the doctor because of persistent clinical manifestations or secondary manifestations of previous complications. In most cases, the foreign body is found incidental to another medical procedure. Here we report a case of small bowel perforation due to ingestion of a sharp foreign body in a 2 years old child. We further elaborate that how, in paediatric age group these conditions are frequently misdiagnosed and usually present late to us. Hence, the increasing need and importance of a thorough pre-op workup, especially in the pediatric age group.

Determination of Factors to Distinguish MIS-C from Acute Appendicitis in Children with Acute Abdominal Pain.

The aim of this study was to make the differential diagnosis between acute appendicitis and multisystem inflammatory syndrome in children (MIS-C) for patients presenting with the complaint of acute abdominal pain (AAP) and to identify the determining factors for the diagnosis of MIS-C. Eighty-one children presenting with AAP/suspected AAP were evaluated. Of these, 24 (29.6%) were included in the MIS-C group (MIS-C/g) and 57 were included in the suspected appendicitis group (S-A/g), which consisted of two subgroups: appendicitis group (A/g) and control observation group (CO/g). Comparing MIS-C/g, A/g, and CO/g, duration of abdominal pain (2.4, 1.5, 1.8 days), high-grade fever (38.8, 36.7, 37°C), severe vomiting, and severe diarrhea were higher in MIS-C/g. Lymphocytes count (LC) was lower, while values of C-reactive protein (CRP), ferritin, and coagulopathy were higher in MIS-C/g (p < 0.05). The optimal cutoffs for the duration of abdominal pain was 2.5 days; the duration of fever, 1.5 days; peak value of fever, 39°C; neutrophil count, 13,225 × 1,000 cell/µMoL; LC, 600 × 1,000 cell/µMoL; ferritin, 233 µg/L; and D-dimer, 16.4 mg/L (p < 0.05). The optimal cutoff for CRP was 130 mg/L (sensitivity 88.9, specificity 100%, positive predictive value 100%, NPV, negative predictive value 92.5%, p < 0.001). All patients in MIS-C/g tested positive by serology by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The duration of abdominal pain, presence of high-grade and prolonged fever, and evaluation of hemogram in terms of high neutrophil count and low LC exhibit high sensitivity and negative predictive value for MIS-C presenting with AAP. In case of doubt, inflammatory markers such as CRP, ferritin, D-dimer, and serology for SARS-CoV-2 should be studied to confirm the diagnosis.

Hyperbilirubinemia and appendicular perforation peritonitis

Background: This study aims to assess the relationship between appendiceal perforation peritonitis and serum bilirubin levels, as has been reported previously in the literature.Methods: A retrospective observational study was conducted at tertiary care hospital of India, namely Government Medical College-Srinagar, Maulana Azad Medical College-Delhi and Government Medical College-Jammu over a period of five years (January 2014 to December 2018). Authors collected and analysed the data of 306 patients, who had reported to the surgery emergency of the afore mentioned hospitals with complaints of acute abdominal pain and were later confirmed and managed as appendiceal perforation peritonitis (localized or generalized). Also, liver function tests of these 306 patients had been sent at the time of admission.Results: Authors had 202 males and 104 females with an average age of 35 years in this study group. Hyperbilirubinemia was noted in 226 patients, with an average serum bilirubin level 1.8 mg/dl. In patients having total leucocyte counts higher than 11000 cells/cumm, the average serum bilirubin level was 2 mg/dl.Conclusions: It may be safely concluded that a pre-operative evaluation of serum bilirubin levels may help us in better diagnosing appendiceal perforation when used in conjunction with other routine and advanced diagnostic modalities.

2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma

Study Objective The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design A case report. Setting A tertiary care hospital. Patients or Participants A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions Laparoscopic surgery. Measurements and Main Results The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful. Conclusion It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.

Acute tubercular appendicitis: A rare presentation

Tuberculosis is a common disease in developing countries like India but gastrointestinal involvement comprises only 3% of all extrapulmonary cases. Primary tubercular appendicitis is rare. We report a case of a 15-year-old girl who presented with complaints of acute abdominal pain, vomiting, and fever for 1 day along with tenderness at the McBurney's point suggestive of acute appendicitis. She underwent laparoscopic appendicectomy. Histopathological report of appendix revealed presence of many epitheloid cells with central necrosis compatible with tuberculosis; hence, antitubercular treatment was started postoperatively. We wish to highlight that primary tubercular appendicitis mimics acute appendicitis in general but requires additional antitubercular treatment along with appendicectomy to avoid complications.

Strongyloidiasis: The Cause of Hypereosinophillia and Duodenal Ulcer in an Immunocompetent Individual

Strongyloidiasis is a common parasitic disease in tropical and sub-tropical regions of the world. Infection with Strongyloides Stercoralis usually remains asymptomatic with peripheral eosinophilia and uncontrolled growth. Consequently, immunocompromised individuals are at a higher risk of complications of this disease. A case of an immunocompetent patient who had complaint of acute abdominal pain and was found to have duodenal ulceration. Laboratory examination revealed significantly elevated absolute eosinophil count at 17000/cmm (normal 0-500/cmm). The stool R/E revealed rhabtidiform larvae suggestive of Strongyloides stercoralis nematode. Endoscopy of upper GIT showed ulcer in duodenum. The patient was treated with weekly dose of Tab Albendazole for two weeks and after that peripheral eosinophilia count became normal. This study found that the elevated eosinophil count played a central role in the pathogenesis.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 109-111

ACUTE ABDOMINAL PAIN IN CHILDREN

Objective: To determine the clinical outcomes of acute abdominal pain andevaluation of symptoms and signs in children admitted in pediatric surgery department.Design: Cohort study. Place and Duration of study: This study was conducted in Departmentof Paediatric Surgery Shaikh Zayed Hospital, Lahore between August 2010 to August 2012.Patients and methods: Children aged 2 to 14 years who presented to emergency departmentwith complaint of acute abdominal pain of less than 5 days duration and admitted in pediatricsurgery department were included. Presenting symptoms, signs, hospital course of patientsand discharge diagnosis were recoded. Data was analyzed by SPSS. Results: Out of 73104patients who were seen in Paediatric emergency 1420 (1.94%) were referred for surgicalevaluation. Out of these 157 children were admitted. Six patients left against medical adviceso 151 patients were studied. Patients were divided into acute appendicitis, non-specificpain abdomen and miscellaneous categories on the basis of discharge diagnosis. Acuteappendicitis was diagnosed in 61(40.4%) patients. The patients who were admitted and nocause of pain abdomen could be found in them, were included in non-specific pain abdomengroup. NSPA group had 39 (25.8%) patients. Rests of the 51 (33.8%) patients were includedin miscellaneous group. Anorexia, fever, pain in right lower quadrant, tenderness in right iliacfossa, guarding, rebound tenderness and tachycardia were all significantly higher in patientswith acute appendicitis. Conclusion: Most of the children with acute abdominal pain wouldnot require surgery. Detailed history and thorough physical examination are cornerstone of thediagnosis.

Abdominal Pain

Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.

Death Due to Isolated Jejunal Tear Following Blunt Abdominal Trauma

Small intestinal injury following blunt abdominal trauma has been widely reported. Isolated jejunal tear which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we report a case of isolated jejunal tear in a 24-year-old male truck driver. He was admitted to a tertiary care hospital in a South Indian Metropolitan city with complaints of acute abdominal pain and tiredness following alleged accidental blunt trauma sustained to abdomen due to steering wheel impact. An isolated jejunal tear and adjacent mesenteric contusion and tear were missed by the treating physician even after preliminary investigations, and thus, the conservative management was instituted. The condition deteriorated gradually, and he succumbed to death. The autopsy revealed transverse tear of jejunum almost involving whole of its circumference on the antimesenteric border and peritonitis. Proper use of radio-diagnostic techniques and timely undertaken explorative laparotomy would have saved the life.