A 65-year-old female underwent passenger traffic accident. She was putting a seat belt. She arrived at authors` emergency department via ground ambulance from other hospital. The patient complained of generalized abdominal pain, and her initial vital signs were blood pressure 101/51 mmHg, heart rate 85, respiratory rate 20, body temperature 36.8℃ and sPO2 97%. A seat-belt sign was seen from her anterior chest wall to lower right abdominal wall. We detected free air and fluid collection in her abdominal cavity of computed tomography scan which was performed at the previous hospital ( Fig. 3.). An emergency laparotomy was performed. About 1 L of fresh blood was collected in the abdominal cavity and a moderate amount of bowel spillage was detected. Multiple mesenteric lacerations were identified 190cm distal area from Treitz ligament and 5cm above from IC valve. Omental tearing was also identified. Cecal perforation was noted on the countermesenteric area. We decided one-stage operation. After adequate hemostasis, the omental and mesenteric tearing were repaired primarily. A partial cecaectomy was performed using stapler on the perforation of the cecum (Fig. 2.). The patient was discharged uneventfully. DISCUSSIONIn a blunt trauma, a cecal perforation is very rare. If the injury is identified without delay, cecal perforation could be managed with one-stage operation (1). Conflict of Interest StatementNo potential conflict of interest relevant to this article was reported.

no mortalities. Mean procedure time was 85 min. Mean length of hospital stay was 2,30 days. Conclusions: IO-ERCP in a simultaneous laparoendoscopic rendezvous is a tailored "single step operation" for the resolution for cholecistocholedocolithiasis, with a similar success rate to standard ERCP, but with low morbidity, especially of acute pancreatitis.

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With the advent of computed tomography scans, trauma surgeons can easily detect intestinal perforations. However, the signs and scans remain non-definitive in some cases. Here, we present two cases of near-missed intestinal perforation: one case was clearly suspected of intestinal perforation, whereas the other was not so apparent. One should consider the possibility of occult intestinal injury for the abdominal trauma.