Small bowell perforation and @entity130 after an unusual blunt XXXX -Case report.

@entity1 @entity548 @entity63 @entity1661 @entity1410 @entity130
INTRODUCTION: In blunt @entity1661 , lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. PRESENTATION OF CASE: The authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon @entity548 . An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent @entity1410 of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the @entity1410 was identified, justified an additional enterectomy, after what the @entity1 recovery progressed uneventfully. DISCUSSION: In this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric @entity1410 , or, in spite of that, a state of low perfusion could have lead to total wall @entity63 of an already irrigation compromised segment. Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and @entity130 are potentially missed due to decreased exploratory laparotomies for blunt @entity1661 . CONCLUSION: Although uncommon, small bowel and @entity130 are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis.
