Laparoscopic Management of Small Bowel Perforation Following Blunt Abdominal Trauma from a Steering Wheel

Abstract

Steering wheel impact during a motor vehicle accident can cause blunt abdominal trauma, which may lead to small bowel perforation. This injury typically occurs due to rapid compression, shearing forces, or increased intraluminal pressure, creating a “blow-out” effect or crushing force that pins the bowel against the vertebral column. The jejunum and proximal ileum are the most commonly injured sites because of their relatively fixed anatomical position. Early evaluation with CT scan of the abdomen is essential to detect free intraperitoneal air or fluid, which may indicate bowel perforation. However, isolated small bowel injuries following blunt steering wheel trauma are rare. Laparoscopic management of small bowel perforation resulting from steering wheel injury is considered a safe, effective, and both diagnostic and therapeutic approach in hemodynamically stable patients. Surgical procedures may include primary repair of the perforation or resection of the affected bowel segment, performed using intracorporeal suturing or laparoscopic-assisted extracorporeal techniques. We report a rare case of small bowel perforation in a 35-year-old man who sustained blunt abdominal trauma following a tractor wheel injury to the abdomen. The diagnosis was made by X-ray chest and abdomen and CT scan of the abdomen showing free intraperitoneal air and fluid, and the patient was successfully managed laparoscopically. The patient had an uneventful postoperative recovery and was discharged on the fifth postoperative day in stable condition. The study therefore concluded that, compared with open surgery, laparoscopic management is associated with less postoperative pain, faster recovery, shorter hospital stays, and potentially lower morbidity.