Jejunal perforation occurring in contact sports BRUCE E. BAKER,*M.D., From the Department of
Syracuse, New York
Orthopaedic Surgery, State University of New York, Upstate Medical Center, Syracuse,
the musculoskeletal system are sports. Much less commonly seen are significant injuries to the abdominal viscera. Splenic and hepatic rupture&dquo;’ are occasionally seen, but certainly uncommonly for the intensity of trauma inflicted on opposing players during contact sports such as American football. This report cites two examples of a rare injury’ occurring in contact sports, that of jejunal perforation following a blow to the abdomen. common m contact
The first case is that of a 20-year-old college student participating in an intercollegiate soccer game. He was heading the ball, was struck in the abdomen while in an elongated position, and had an acute onset of abdominal discomfort. At laparotomy, a 3-cm perforation in the jejunum on the mesenteric side was revealed. The patient had primary closure of the defect and went on to an uneventful recovery. CASE 2
The second case was that of a 20-year-old college football player who was injured in a practice session. The patient was playing the position of tight end, was elongated during a pass reception, and struck in the abdomen with a helmet. He had the immediate onset of abdominal pain which subsided quickly, but was followed by nausea and mild discomfort while bowel sounds remained active. During the next 9 hr of observation, the patient developed more severe discomfort and was
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At laparotomy, a 5-mm perforation was noted in the jejunum on the mesenteric side. This was closed and the patient had an uneventful recovery and returned to football competition.
Significant abdominal injuries during contact sports are relatively uncommon. Fitzgerald et al.2 reviewed 200 cases of nonpenetrating abdominal injuries resulting in surgical exploration and found that the vast majority of abdominal explorations followed motor vehicle accidents. Blunt trauma such as kicks and blows to the abdomen was the reason for exploration in 6.5% of those cases studied. Injury to the spleen, liver, and kidney are much more commonly seen in blunt trauma cases than significant injury to the small intestine. 1,4-8 Williams and Sargene have described an experimental mechanism of intestinal rupture following blunt trauma, which indicates that fixation of a segment of bowel across the spine results in a midline injury to the segment without an increase in pressure in the lumen. These fmdings combined with the location of injuries suggest that a shearing force between two opposing surfaces is the primary cause of intestinal injury due to blunt trauma. The injuries presented occurred in players who were in a semirelaxed position with the body in an elongated state and a blow applied to the abdomen, similar to the mechanism described by Williams. Frequently players of contact sports are injured with blows to the abdomen and have a rapid return of function with disappearance of their pain. One must always consider the possibility of visceral damage. Repeat evaluations must be made, particularly in the first 12 hr, to rule out more subtle visceral disruption in those patients with persistent signs and symptoms. 403
Two cases of jejunal rupture following blunt trauma, occurring in participants of contact sports, have been reported. Additionally, a possible mechanism of injury is described. REFERENCES 1 Kakos
GS, Grosfeld JL, Morse TS Small bowel injuries in children after blunt abdominal trauma Ann Surg 174: 238-241, 1971 2. Fitzgerald JB, Crawford ES, DeBakey ME: Surgical considerations of non-penetrating abdominal injuries, an analysis of 200 cases. Am J Surg 100: 22-29, 1960
3. Williams RD, Sargent FT The mechanism of intestinal injury in trauma. J Trauma 31: 288-294, 1963 4. Harrison RC, Debas HT Injuries of the stomach and duodenum. Surg Clin North Am 52. 635-648, 1972 5 Grosfeld JL, Cooney DR: Pancreatic and gastrointestinal trauma in children Pediatr Clin North Am 22. 365-377, 1975 6. Hendren WH, Kim SH: Trauma of the spleen and liver in children. Pediatr Clin North Am 22. 349-364, 1975 7. Rosoff L, Cohen JL, Telfer N, et al Injuries of the spleen Surg Clin North Am 52 667-685, 1972 8. Razali H, Thomas WMC: Isolated jejunal injuries arising from blunt abdominal trauma. Br J Accident Surg 6. 33-35, 1974