Delayed Colonic Perforation Following Blunt Abdominal Trauma: A Diagnostic Dilemma

Hollow viscus injuries following blunt abdominal trauma are relatively uncommon and may present with delayed and masked clinical features, resulting in a delay in diagnosis. A 35-year-old male presented to the hospital after a road traffic accident with isolated blunt abdominal trauma. He was hemodynamically stable with mild abdominal tenderness. Initial ultrasonography and non-contrast computed tomography showed minimal hemoperitoneum without definitive bowel injury or solid organ injury. The patient remained clinically stable for 48 hours except for persistent ileus. A repeat ultrasonography and erect abdominal radiograph subsequently revealed pneumoperitoneum suggestive of a hollow viscus injury. Emergency exploratory laparotomy demonstrated fecal peritonitis due to a traumatic perforation of the descending colon. The perforated damaged colon was resected with resultant end colostomy of the proximal end and blind closure of the distal end. The postoperative course was uneventful. This case highlights the importance of a high index of suspicion for delayed colonic perforation following blunt abdominal trauma. Serial clinical evaluation and repeat imaging are crucial for timely diagnosis and prevention of morbidity.