Traumatic Intramural Haematoma of the Proximal Jejunal Loop

Abstract

That injury to the abdominal viscera can result from a blow by a blunt object on the abdominal wall has been recognized from the earliest days of medical knowledge; and that such a blow can leave no visible trace upon the skin of the abdominal wall was also known at that time. For, in the third century B.C., Aristotle is reputed by Morgagni (1761) (Epistola, quoted by Poer and Woliver) to have written that 'A slight blow will cause rupture of the intestine without injury to the skin'. Poer and Woliver (1942) reviewed the literature of injuries of the intestines and mesenteries due to non-penetrating abdominal trauma and found numerous references in the literature from 1875 onwards, thus proving the continual occurrence of such injuries. These authors stressed the importance of early diagnosis, for all the cases reported up to that time were associated with rupture of the intestines or with injuries to the mesenteries. A mortality of 35% was found in those cases which were diagnosed and treated by operation at an early stage. For those in which there was a delay of over 12 hours the mortality rose to 70%. Counseller and McCormack (1935) also published a survey of subcutaneous rupture of the intestine. Seventy-seven of the 1,183 cases found in the literature up to that time occurred in children under the age of 12 years. At all ages the jejunum was most often involved (447 occasions) and the ileum slightly less often (412 cases). In 29 instances the site of injury was either not noted or no perforation was found at laparotomy. In this group there may have occurred cases of haematoma of the bowel wall not considered worthy of note or record.In yet a third and even earlier survey (Vance, 1923), it was stated that the jejunum and ileum were about equally involved in injuries of the subcutaneous type, and that the most frequently affected sites were those of natural fixation in the duodenojejunal area and the ileo-caecal junction.

Subserosal Haematoma of the Ileum

“…Subserosal haematomas leading to intestinal obstruction have been reported by Zabin (1952), Lampert, Goodfellow and Wachowski (1954), and Robbarts (1957), but in those cases the children were older, with a definite history of non-penetrating abdominal injury, and examination of the resected specimens did not show haemangiomas. They were usually found near the more fixed zones of the gut, mainly near the duodenojejunal flexure.…”

“…tumour, duplication. In the traumatic cases also we favour resection and feel that the simple evacuation of the blood clot, although successfully used by Lampert et al (1954) and Robbarts (1957) should only be employed in exceptional circumstances when resection is too risky or contra-indicated.…”

Traumatic Intramural Jejunal Hematoma: A Case Report and Review of Literature

“…Bleeding diathesis needs to be ruled out in children presenting with hematoma [ 3 ]. In contrast to adults, children are vulnerable to developing jejunal hematoma on account of the smaller anteroposterior depth of the abdominal cavity and underdeveloped abdominal musculature that prevent them to endure the traumatic insult [ 4 ]. In our case, the coagulation profiles were normal.…”

Traumatic Jejunal hematoma in childhood—A case report and review of literature

“…Blunt abdominal trauma at childhood and adolescence ages differ in that the abdominal musculature has not developed its maximum strength and thickness, the lower rib cage margin is free with high flexibility and the anteroposterior depth of the abdominal cavity is smaller than in adults accounting for the increased risk of jejunal hematoma [4].…”