Case Report: Traumatic Intestinal Perforation Following a Minor Fall in an Elderly Male

Introduction

Traumatic intestinal perforation is a serious but often overlooked consequence of blunt abdominal trauma. In elderly patients, physiological changes and subtle clinical presentations can delay diagnosis, leading to septic shock and high mortality. This case highlights how even a minor fall can result in life-threatening intra-abdominal injury.

Case Summary

An 80-year-old male presented to the emergency department with hypotension and altered sensorium three days after a domestic fall. The fall was reportedly mild, with no external injuries or immediate abdominal pain.

On arrival, his vitals were:

• Blood pressure: 70/40 mmHg
• Pulse: 124/min
• Respiratory rate: 28/min
• Temperature: 99°F

On examination, the abdomen was distended, rigid, and silent on auscultation, with diffuse tenderness and guarding. There was no evidence of external trauma.

Initial resuscitation was started with intravenous fluids, oxygen, and broad-spectrum antibiotics. An erect abdominal X-ray revealed free gas under the right hemidiaphragm. Contrast-enhanced CT abdomen confirmed a distal ileal perforation with pneumoperitoneum and minimal free fluid, consistent with blunt bowel injury.

A diagnosis of traumatic intestinal perforation with septic shock secondary to blunt abdominal trauma was made.

Discussion

Blunt injury to the small bowel is uncommon, occurring in less than 5% of abdominal trauma cases, but can have catastrophic outcomes if missed. The mechanism usually involves sudden compression of bowel loops against the vertebral column or tearing at fixed points like the ileocecal or duodenojejunal junction.

In elderly patients, decreased pain perception, frailty, and delayed inflammatory response often mask early symptoms. The absence of solid organ injury with free fluid or gas on imaging should prompt suspicion of hollow viscus perforation.

Early recognition and prompt surgical intervention remain critical for survival. Delays beyond 24 hours markedly increase morbidity and mortality due to progressive peritonitis and sepsis.

Conclusion

This case emphasizes the need for high clinical suspicion in elderly patients with even minor blunt abdominal trauma. Subtle signs such as tachycardia, abdominal distension, or free air on imaging should never be dismissed. In trauma, especially in the aged, small falls can cause deep wounds.