Delayed diagnosis of isolated jejunal perforation following blunt abdominal trauma

Künt karın travması sonrası gelişen izole jejunum perforasyonu, ilk muayene ve radyolojikdeğerlendirmelerle kolayca fark edilemeyen nadir bir durumdur. Bu sunumda; acil servisebaşvuran ve ilk muayene, radyolojik incelemeleri normal değerlendirilen künt karın travmalı birolgunun müşahede altında iken tekrarlanan fizik muayene ve kontrol görüntülemeleri ile 8 saatsonra tespit edilen izole jejnum perforasyonu sunulmuştur. Bu tür travma olgularının gözlemaltında tutulması benzer hayati sorunların tespiti için son derece önemlidir.

Künt karın travması sonrası gelişen izole j ej unum p erf orasyonu tanısında gecikme

Isolated jejunal perforation due to blunt abdominal trauma is a rare clinical condition and it may beeasily unnoticed during the first examination or radiological studies, so that a delay in diagnosis iscommon. We present a case with isolated jejunal perforation after a blunt abdominal trauma whichwas not diagnosed at the first examination in the emergency department. The initial radiologicalstudies were also normal and at the observation period small intestinal injury was diagnosed eighthours later with serial physical examinations and control radiological studies. Because diagnosingan isolated small intestinal injury is still a medical challenge, medical observation is a lifesavingmeasure.

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1. Kılbaş Z, Demirbaş S, Coşkun AK, Kozak O, Tufan T. Künt travmaya bağlı (inek süsmesi) geç dönem ortaya çıkan jejunum perforasyonu: Olgu sunumu. Bakırköy Tıp Dergisi 2012; 8: 50-2.
2. Abbasakoor F, Vaizey C. Pathophysiology and management of bowel and mesenteric injuries due to blunt trauma. Trauma 2003; 5: 199-214.
3. Watts DD, Fakhry SM; EAST Multi-Institutional Hollow Viscus Injury Research Group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma 2003; 54: 289-94. Erratum in: J Trauma 2003; 54: 749.
4. Fakhry SM, Watts DD, Luchette FA; EAST Multi-Institutional Hollow Viscus Injury Research Group. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma 2003; 54: 295- 306.
5. Parvin S, Smith DE, Asher WM, Virgilio RW. Effectiveness of peritoneal lavage in blunt abdominal trauma. Ann Surg 1975; 181: 255-61.
6. Schenk WG 3rd, Lonchyna V, Moylan JA. Perforation of the jejunum from blunt abdominal trauma. J Trauma 1983; 23: 54-6.
7. Powell RW, Green JB, Ochsner MG, Barttelbort SW, Shackford SR, Sise MJ. Peritoneal lavage in pediatric patients sustaining blunt abdominal trauma: a reappraisal. J Trauma 1987; 27: 6-9.
8. Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg 1994; 168: 670-5.
9. Dente M, Santi F, Solinas L, Bagarani M. Laparoscopic diagnosis and management of jejunal perforation resulting from accidental toothpick ingestion. Am Surg 2009; 75: 178-9.