997 Traumatic Jejunal Rupture Following Gaelic Football Game. Case ReportC Croitoru, C Mallon, M Harron
Abdominal injury accounts for just 6.3% of injuries in sport. The most common mechanisms are contacts with a player (74.5%), a surface (8.1%) or equipment (0.6%). Only twelve cases of Jejunal rupture are described in the literature.
This case involves a young Gaelic football player who had significant abdominal contact with other players’ knees. He experienced nausea and left flank pain radiating to the groin. At the Emergency Department the heart rate was 95 beats per minute and blood pressure was 120/70 mmHg. There was bruising in the left flank at the impact site and some guarding. Initial investigations showed normal inflammatory markers and a normal Chest X-ray. Nine hours later the white cell count had increased to 17.85x10^9 and CRP to 106mg/L. Abdominal and Pelvic CT scanning suggested a bowel injury with free fluid in the left flank and pelvis.
Exploratory laparotomy identified a jejunal rupture 10cm distal to the duodenal-jejunal flexure. A primary two-layer repair was performed. Antibiotic and anti-fungal cover were prescribed, and he was discharged well on day 5.
Owing to the rarity of bowel injury after blunt trauma, soft peritoneal signs and radiological insensitivity, the diagnosis of small bowel perforation is often delayed and can be associated with marked morbidity and mortality. Serial examinations and a high index of suspicion is required to detect bowel injuries in the case of blunt abdominal trauma in contact sports.