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Small bowel injuries are uncommon after blunt abdominal trauma and are usually due to high-energy deceleration injury, often in relation to motor vehicle accidents.1 Reports of intestinal perforation during low-energy impacts, such as bicycle falls, are extremely rare.2 We report on two cases of jejunal transection that occurred after apparently trivial blows to the central abdomen. We must keep the possibility of occult intestinal injury in mind for all patients presenting with blunt abdominal trauma, despite minimal physical signs.
Case report 1
A 12-year-old boy fell off his bicycle and sustained a handlebar injury to his central abdomen. He presented with severe abdominal pain. Physical examination was normal apart from an area of mild tenderness to the right paraumbilical region, which corresponded to a 3×2-cm superficial abrasion caused by the handlebar. Abdominal ultrasonography showed an oedematous loop of small bowel, but no signs of solid organ …
Competing interests: None declared.
This work was presented in abstract form at the Royal Society of Medicine President’s Day Meeting in Winchester, UK (Adrian Tanner prize session) on 8 July 2005.