Laparoscopic Management of Jejunal Perforation Following Steering Wheel Injury

Abstract

Jejunal perforation, a tear in the jejunum, can occur as a result of blunt abdominal trauma (BAT), such as impact from a steering wheel during a car or truck accident. This injury typically results from the sudden compression of the abdomen against the steering wheel, leading to a rapid rise in intraluminal pressure and causing a “blow-out” perforation. The jejunum, particularly near the ligament of Treitz, is prone to injury due to its relatively fixed position and proximity to the vertebral column. During blunt trauma, this segment can be compressed against the spine, resulting in perforation, commonly along the antimesenteric border, which is more vulnerable due to its thinner wall and less vascular support. Early recognition, prompt diagnosis, and timely surgical intervention are critical for improving outcomes in such cases. Both open and laparoscopic approaches are effective, though laparoscopic management has emerged as a safe and feasible option in hemodynamically stable patients, offering faster recovery and reduced morbidity. We present a case of 45-year-old truck driver who sustained blunt abdominal trauma in a road traffic accident and was found to have a jejunal perforation. The patient was successfully managed with laparoscopic surgery. Laparoscopic surgery is preferred in hemodynamically stable patients and offers the advantage of being both diagnostic and therapeutic. The perforation can be repaired using either intracorporeal or extracorporeal suturing techniques. Compared to traditional open surgery, laparoscopy is associated with less postoperative pain, faster recovery, shorter hospital stays, and potentially lower morbidity.