A Case of Gastrointestinal Perforation Caused by Blunt Abdominal Trauma in a Child Managed by Conservative Treatment

Abstract

Although a gastrointestinal perforation is normally regarded as an indication for an emergency operation, we experienced a rare case in which we were able to avoid an operation by cautious observation. An 8-year-old boy who fell from the top of a horizontal bar was referred to our hospital because of abdominal pain and non-bilious vomiting. Upon admission, upper abdominal pain with localized mild peritoneal irritation was noted. Abdominal CT with oral contrast medium and echo revealed a small amount of ascites in the pelvis without any free air or leakage of the contrast medium. Although an intestinal perforation was suspected, we treated him conservatively because his general condition was good. Three days after admission, his abdominal symptoms completely disappeared with only the symptom of fever remaining. Four days later, oral intake was started and five days thereafter, a plain X-ray film showed contrast medium pooling in the rectovesical pouch. At that time, only fever was noted without any abdominal symptoms, and thus conservative treatment was continued. Eight days after admission, the fever disappeared and the patient was discharged from hospital ten days after admission.