Traumatic Intramural Jejunal Hematoma: A Case Report and Review of Literature

Abstract

We report a case of a jejunal hematoma in a six-year-old boy with an antecedent history of trauma. The development of duodenal hematoma post blunt abdominal trauma is well known; however, the jejunal hematoma is very rare. A six-year-old boy was brought to Tata Main Hospital (TMH), Jamshedpur, with pain abdomen, associated with a history of trauma to the abdomen. There were no signs of peritonitis on clinical examination. Initial ultrasonology revealed mild free fluid in the abdomen. CT abdomen was suggestive of intramural hematoma in the jejunum. Exploratory laparotomy findings were in concordance with CT abdomen findings. Resection-anastomosis of the jejunum was done. The patient was discharged uneventfully on postoperative day 7. Blunt trauma to the abdomen is the principal cause of jejunal hematoma. The trauma in the majority of cases is trivial and usually the patients present late. The symptoms range from mild abdominal pain to intestinal obstruction with acute abdomen. A trial of conservative management is justifiable in a stable patient. If no clinical improvement is seen, surgical intervention is indicated. Surgical exploration was necessary because of signs and symptoms of intestinal obstruction due to jejunal hematoma. In pediatric cases, loss of functional bowel length and sudden decompensation due to expanding hematoma favor early exploration.

Keywords: acute abdomen; bilious vomiting; blunt abdominal trauma; intestinal obstruction; jejunal intramural hematoma.

Figure 1. X-ray abdomen with features of intestinal obstruction

Figure 2. Sagittal section of abdomen showing hematoma in jejunum (blue arrow)

Figure 3. Hematoma in jejunum in coronal section of abdomen (blue arrow)

Figure 4. Intraoperative picture showing intramural hematoma in loop of jejunum

Figure 5. Jejuno-jejunal anastomosis post resection of jejunal hematoma