Late presentation of jejunal perforation due to blunt abdominal trauma (Cow bump): Case report

Isolated small bowel injury due to blunt abdominal trauma is very rare, and motor vehicle accident is the leading cause. In this study, we present a case of 78 year-old man with isolated jejunal perforation due to blunt abdominal trauma (cow bump). At admission, his general condition was down and vital signs were within abnormal limits. On physical examination, muscular rigidity and rebound tenderness was obtained in the whole abdomen. Computed tomography revealed intestinal perforation by showing free air and free uid in the abdomen. At exploration, 2-cm perforation zone 110 cm distal to the Treitz ligament, in the antimesenteric side of jejunum, was seen and also the small bowel was ischemic and edematous. The patient underwent two-staged surgery; in the first step, the abdomen was irrigated, aspirated and loop jejunostomy was performed. In the second step, 72 hours later, to avoid the complications of proximal jejunostomy, stoma closure was performed. In conclusion, diagnosis of small bowel perforation after blunt trauma is challenging and the mechanism of injury, history, and serial physical examination and computed tomography play an important role in diagnosis.