PERITONITIS SECONDARY TO PERFORATION OF A HOLLOW VISCUS FROM BLUNT ABDOMINAL TRAUMA. CASE PRESENTATION AND LITERATURE REVIEW

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0820

Abstract

Introduction: Perforation of hollow viscera secondary to blunt abdominal trauma is rare but associated with high morbidity. The clinical presentation can be insidious, and delayed diagnosis increases the risk of peritonitis and sepsis. Objective: To describe the diagnostic and therapeutic approach to a case of secondary peritonitis due to probable perforation of a hollow viscus following blunt abdominal trauma, and to summarize recent evidence on its epidemiology, diagnosis, and management. Case presentation: A 68-year-old man reported that 48 hours earlier he had suffered trauma from a wooden post to the right iliac fossa, with severe pain that worsened with movement. Upon admission, the picture was consistent with localized peritoneal irritation, progressing to peritoneal compromise. Clinical evaluation and complementary tests (laboratory and imaging) pointed to a hollow viscus injury and secondary peritonitis. Timely surgical management was performed according to intraoperative findings (control of the focus, repair/resection of the injured segment, and peritoneal cleansing) plus targeted antimicrobial therapy and hemodynamic support. The postoperative course was favorable (chronological and microbiological details to be completed according to clinical history). Review methods: Narrative search of biomedical databases (last 10 years), focusing on blunt trauma, hollow viscus perforation, sensitivity of diagnostic methods (CT, FAST, radiography), time to surgery, and clinical outcomes. Review results: The evidence highlights that contrast-enhanced CT is the most effective tool for detecting indirect signs of perforation (pneumoperitoneum, contrast extravasation, parietal thickening, free fluid). A delay of >24 hours from the trauma is associated with a higher complication rate. The standard treatment is control of the focus with a surgical approach (laparotomy or laparoscopy depending on stability and expertise), plus broad-spectrum antibiotic therapy adjusted to cultures. Conclusions: In the presence of persistent pain and signs of peritoneal irritation after blunt trauma, a high index of suspicion for hollow organ perforation should be maintained. Early identification and timely surgical control, together with appropriate antibiotics, are crucial in reducing complications and mortality. This case illustrates the need for protocols that integrate clinical findings, imaging, and early surgical decision-making.

Keywords: blunt abdominal trauma; hollow organ perforation; secondary peritonitis; computed tomography; control of the focus.