Multiple Distal Ileal Perforations Following Blunt Abdominal Trauma in a Child: A Rare Case Report

Abstract

Blunt abdominal trauma (BAT) is a significant cause of morbidity in the pediatric population, with injuries to solid organs occurring far more commonly than injuries to the hollow viscera. Small bowel perforation resulting from low-energy blunt abdominal trauma is rare and frequently presents with delayed or subtle clinical manifestations, posing a diagnostic challenge. Timely recognition, accurate diagnosis, and early surgical intervention are essential to minimize morbidity and improve clinical outcomes. We report the case of a 13-year-old boy presented with severe abdominal pain one day following a fall while drinking water, resulting in blunt abdominal trauma and a lacerated wound over the right iliac fossa. The wound had been sutured at a peripheral hospital. He subsequently developed progressively worsening diffuse abdominal pain associated with fever and hematuria. Contrast-enhanced computed tomography (CECT) revealed disruption of the anterior abdominal wall musculature, multiple distal ileal perforations, pneumoperitoneum, hemoperitoneum, and traumatic peritonitis without solid organ injury. Emergency exploratory laparotomy demonstrated seven perforations involving a 15-20 cm segment of distal ileum approximately 20-25 cm proximal to the ileocecal junction, associated with a large mesenteric tear. Segmental resection of approximately 20 cm distal ileum and Primary end-to-end ileoileal anastomosis was done. The postoperative recovery was uneventful. Persistent abdominal pain after even trivial blunt abdominal trauma should prompt evaluation for hollow viscus injury. This case emphasises that timely CT imaging and early surgical intervention are essential for preventing life-threatening complications and improving patient outcomes.