Incidental small bowel perforation in an isolated head injury
DOI:
https://doi.org/10.18203/2349-2902.isj20252689Keywords:
Spontaneous Gastrointestinal perforation, Abdominal compartment syndrome, HistopathologyAbstract
Spontaneous gastrointestinal perforation is a rare occurrence, most associated with an infectious cause precipitated by an underlying co-morbidity. This case report discusses a 39-year-old trauma patient that sustained an isolated gunshot to his face. The patient subsequently developed spontaneous bowel perforations of the duodenum and ileum while intubated in ICU. Despite extensive laboratory and histopathological testing, no definitive etiology was identified. This case report highlights the importance of suspecting and recognizing bowel perforation and abdominal compartment syndrome promptly in an intubated ICU patient. The report emphasizes the necessity of early surgical source control and the role histopathology plays in diagnosis of underlying pathologies. This case contributes to the limited literature surrounding spontaneous gastrointestinal perforation where the etiology is inconspicuous.
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References
Mahajan G, Kotru M, Sharma R, Sharma S. Usefulness of histopathological examination in nontraumatic perforation of small intestine. J Gastrointest Surg. 2011;15(10):1837-41. DOI: https://doi.org/10.1007/s11605-011-1646-z
Azuhata T, Kinoshita K, Kawano D, Komatsu T, Sakurai A, Chiba Y, et al. Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock. Critical Care. 2014;18(3):87. DOI: https://doi.org/10.1186/cc13854
Sun S, Wang D, Dong D, Xu L, Xie M, Wang Y, et al. Altered intestinal microbiome and metabolome correspond to the clinical outcome of sepsis. Critical Care. 2023;27(1):127. DOI: https://doi.org/10.1186/s13054-023-04412-x
De Waele JJ. Early source control in sepsis. Langenbeck's Arch Surg. 2010;395(5):489-94. DOI: https://doi.org/10.1007/s00423-010-0650-1
Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J Gastroenterol. 2014;20(29):9990. DOI: https://doi.org/10.3748/wjg.v20.i29.9990
Veldsman L. Case study: small bowel perforation secondary to ileal tuberculosis: intensive care unit case study. South African J Clin Nutrit. 2015;28(1):44-9. DOI: https://doi.org/10.1080/16070658.2015.11734525
Retief PJ. Non-specific ulceration of the small bowel. South African Med J. 1966;40(27):649-50.
Huang H, Xie L, Zheng Z, Yu H, Tu L, Cui C, Yu J. Mucormycosis-induced upper gastrointestinal ulcer perforation in immunocompetent patients: a report of two cases. BMC Gastroenterol. 2021;21(1):311. DOI: https://doi.org/10.1186/s12876-021-01881-8
Heininger A, Haeberle H, Fischer I, Beck R, Riessen R, Rohde F, et al. Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis. Critical Care. 2011;15(2):77. DOI: https://doi.org/10.1186/cc10069
Michalopoulos N, Triantafillopoulou K, Beretouli E, Laskou S, Papavramidis TS, Pliakos I, et al. Small bowel perforation due to CMV enteritis infection in an HIV-positive patient. BMC Res Notes. 2013;6(1):45. DOI: https://doi.org/10.1186/1756-0500-6-45
Eid HO, Hefny AF, Joshi S, Abu-Zidan FM. Non-traumatic perforation of the small bowel. African health sciences. 2008 Sep 10;8(1):36-9.
Wu J, Shu P, He H, Li H, Tang Z, Sun Y, et al. Predictors of mortality in patients with acute small-bowel perforation transferred to ICU after emergency surgery: a single-centre retrospective cohort study. Gastroenterol Rep. 2022;10:54. DOI: https://doi.org/10.1093/gastro/goab054