Abstract
A 65-year-old man complained of pain in the left lower abdomen and inguinal region right after he had made a diving catch during a softball game. As the abdominal pain persisted for 4 days after the injury, he visited a neighboring doctor, who suspected intestinal obstruction and referred him to our hospital.
Physical examination revealed abdominal distension with no peritoneal signs but tenderness, and left inguinal hernia without incarceration. Abdominal radiography revealed no free air but showed niveau in the small intestine. CT disclosed ascites and perforation of the small intestine.
The operative findings of the emergency surgery were turbid ascites and swelling of the entire small intestine. There was also a 1-cm perforation in the antimesenteric site of the ileum. After peritoneal lavage, a loop ileostomy was performed.
Considering the mechanism of the intestinal perforation, the intestine had ruptured in the hernial sac as a result of the rapid elevation of abdominal pressure from the abdominal blow. As peritoneal signs or free air are not always noted, small intestinal perforation is difficult to diagnose. However, our case is extremely rare in that the perforation site was precisely identified by CT.
