Abstract
A 33-year old male was transferred to the ER of our institution by ambulance after a head-on vehicle collision. Initial physical examination did not reveal any abnormal findings in the patient's abdomen except pressure marks from the seatbelt and the patient was released with a diagnosis of contusions of the chest and abdomen. Later, the patient returned to the hospital with increasing abdominal pain. Tenderness was observed at the patient's lower left abdomen. An abdominal CT scan with contrast-enhancement showed small amounts of ascites and exiguous free air at the upper left quadrant. Thickening of the jejunal wall adjacent to the free air was also noted and an operation was performed with the diagnosis of traumatic perforation of the small intestine. Laparoscopic examination identified a perforation at the jejunum approximately 20cm distal to the Treitz ligament. Several other damaged areas were observed but were limited to the serosa of the jejunum around the Treitz ligament. The perforation was restored from a small incision at the upper abdomen under direct vision. The patient recovered and was discharged 6 days after the operation. Traumatic perforation of the small intestine is rare and difficult to locate pre-operatively. The present case suggested that laparoscopic evaluation prior to surgical repair helps determine the location of a perforation.
