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Updated: Jun 13, 2026

Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Biphasic small bowel perforation after blunt abdominal trauma: a case report of delayed ischaemic progression and
Martin Larisch1, Jerome Martin Laurence1,2, Basavaraj Mundasad1
1General Surgery Department, Armidale Rural Referral Hospital, Hunter New England Health Services, 226 Rusden Street, Armidale NSW 2350, Australia.
Abstract:
Blunt bowel and mesenteric injuries (BBMI) are diagnostically challenging and may evolve despite apparent radiological resolution. This case describes biphasic small bowel perforation following non-operative management (NOM) after blunt abdominal trauma, highlighting limitations of conservative strategies and the need for prolonged vigilance. A 57-year-old woman sustained a Grade 4 small bowel perforation after a motor vehicle collision. She presented 7 days post-accident with abdominal pain but was haemodynamically stable and elected NOM. Interval computed tomography at 23 days demonstrated apparent resolution. At 21 weeks, she re-presented with crescendo abdominal pain, nausea, and vomiting. Imaging confirmed recurrent perforation at the original site. Laparotomy revealed a 3 cm full-thickness perforation adjacent to a chronic fibrotic stricture and mesenteric defect. Ileocolic resection was performed. Radiological resolution does not equate to definitive healing in high-grade BBMI. Trauma-induced chronic ischaemia may drive delayed stricture formation and late perforation, warranting structured long-term follow-up, and patient education.
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