Intestinal injury can be seen in both blunt and penetrating trauma to the abdomen. Blunt abdominal trauma typically result in injuries to the solid organs. However, approximately 3% of blunt abdominal traumas can result in intestinal injuries. Intestinal injuries are usually caused by the intestines being crushed between an external object and internal structures. This can be common in patients with prior abdominal surgeries. Surgeries increase the risk of adhesion formation which can lead to traction and shear injuries. Traction and shear injuries to the intestines can cause devascularization of the affected tissue further complicating intestinal injury. In this case, we will discuss a 49-year-old Caucasian male presenting with small bowel obstruction and perforation after being attacked by a deer. The patient has a past medical history of chronic back pain and a past surgical history of abdominal hernia repair 2 years ago. He presented to the Emergency Department (ED) with complaints of abdominal pain and chest pain that had been ongoing since he was charged to the ground by a deer 3 days prior. Patient was initially evaluated at a different emergency department on the day of occurrence and was reported to have a normal abdominal scan followed by repairs of multiple superficial lacerations. He was then discharged with a prescription for Augmentin. Patient presented to our ED with complaints of worsening right abdominal pain. Physical exam revealed moderate tenderness to the right anterior and inferior lateral chest wall. There was severe tenderness and erythema to the right upper and lower abdomen that extended to the right flank. Skin revealed mottling in bilateral lower extremities that extended proximally to his lower abdomen with focal epigastric abdominal ecchymosis. CBC was remarkable for an elevated white count of 14.1 with neutrophils at 87.2% and Sodium of 126. His liver function tests and lactate were within normal limits. A CT abdomen/pelvis with contrast was obtained revealing a right lower quadrant hernia defect containing dilated small bowel loops proximal to identified transition point with multiple foci of gas extending into the soft subcutaneous tissues suggestive of bowel injury. Due to these concerning findings, patient was immediately started on Vancomycin and Zosyn and general surgery was consulted. Patient was then taken for an exploratory laparotomy where he was found to have a segment of strangulated small bowel with identified portions of perforation located within the ventral hernia that was previously repaired. The decision was then made to resect this portion of the bowels.

References:

1. Pastorino A, Alshuqayfi AA. Strangulated Hernia. [Updated 2021 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555972/
2. McMahon KR, Balasubramanya R. Intestinal Trauma. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557624/