2025 Volume 45 Issue 1 Pages 29-32
A 77-year-old man presented to our emergency department with persistent abdominal pain after having being accidentally struck in the abdomen (was kneed by his 5-year-old granddaughter) while sitting on a sofa at home. Initial contrast-enhanced CT imaging showed no evident free intraperitoneal gas, but a small amount of ascites in the pelvic, and the patient was admitted for observation. A follow-up CT scan the following morning demonstrated the presence of free intraperitoneal gas and an increase in the ascites, and we performed emergency surgery. Intraoperative exploration through a laparotomy revealed a 5-mm perforation in the small intestine, approximately 150 cm from the ligament of Treitz, which we closed by suturing. Additionally, a left inguinal hernia (classified as type M2 by the Japanese Hernia Society) was also identified. A review of the initial CT images revealed a small amount of free gas within the hernia sac. Bowel perforation within a hernia sac due to a sudden increase of the intra-abdominal pressure is a rare occurrence. A possible association with a pre-existing left inguinal hernia was suggested in this case. We report this case, along with a literature review on traumatic bowel perforation associated with inguinal hernias.
