Occult Small Bowel Injury With Delayed Retroperitoneal Abscess Formation After Blunt Trauma: A Case Report

Blunt abdominal trauma can result in bowel injury, but diagnosis is often delayed because early clinical and radiological findings are non-specific. We report a 64-year-old man with pelvic fractures following a road traffic collision who was initially haemodynamically stable, with no definite gastrointestinal injury on computed tomography. Subsequent imaging demonstrated retroperitoneal gas adjacent to a psoas haematoma, without clear evidence of hollow viscus perforation. Despite remaining clinically well, he developed sepsis on day seven post-injury. Repeat imaging revealed progression of retroperitoneal gas, prompting exploratory laparotomy, which revealed a pelvic abscess and non-viable ileum without an identifiable perforation. This case highlights the potential for delayed occult bowel injury following blunt trauma and underscores the importance of sustained clinical vigilance, particularly in patients with complex anatomy or prior abdominal surgery.