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Delayed intestinal stenosis after blunt abdominal trauma: report of a case
Insights
Delayed jejunal stenosis can occur after blunt abdominal trauma, even months later. Early CT scans may show subtle signs, with later barium studies revealing complete obstruction.
Area of Science:
- Pediatric Surgery
- Abdominal Imaging
- Gastrointestinal Radiology
Background:
- Blunt abdominal trauma can cause subtle intestinal injuries.
- Delayed intestinal stenosis is a potential complication months after initial trauma.
Observation:
- A 12-year-old boy experienced delayed jejunal stenosis post-blunt abdominal injury.
- Initial CT scans revealed mesenteric infiltrates and bowel wall enhancement.
- Barium studies showed a "bird-beak" sign and mucosal swelling, progressing to complete duodenojejunal obstruction.
Findings:
- Subtle initial findings can mask significant underlying intestinal injury.
- Delayed diagnosis of jejunal stenosis is possible following blunt abdominal trauma.
- Imaging findings evolved over time, from subtle CT signs to complete obstruction on barium studies.
Implications:
- Highlights the importance of vigilant follow-up imaging for blunt abdominal trauma.
- Suggests considering delayed stenosis in pediatric patients with prior abdominal trauma and vague symptoms.
- Emphasizes the diagnostic utility of serial imaging modalities like CT and barium studies.
Abstract:
Major intestinal injury may be present with very subtle clinical and/or imaging findings. Sometimes, delayed intestinal stenosis may occur even several months after the blunt abdominal trauma. We present a 12-year-old boy with delayed jejunal stenosis following blunt abdominal injury in a car collision. Computed tomography (CT) scan showed streaky infiltrates in the mesentery and fluid densities in the bilateral anterior pararenal spaces as well as enhancement of bowel wall on the 2nd day after trauma. A "bird-beak" sign at the proximal jejunum with diffuse mucosal swelling of jejunal loops were seen on barium follow-up study on the 7th day. Complete obstruction at the duodenojejunal junction was identified by the follow-up barium examination on the 29th day.