Delayed Small Bowel Perforation Due to Blunt Abdominal Trauma and Peri-Appendicitis in a Patient with Situs Inversus Totalis : A Report of a Case

Background : Delayed intestinal perforation after blunt trauma is very rare. Peri-appendicitis is the serosal inflammation of the appendix, which is generally caused by extra-appendicular sepsis. Our purpose is to present this case with delayed ileum perforation after blunt trauma and peri-appendicitis. Case report : A 29-year-old male patient presented with abdominal pain starting from the left lower region, diffusing to all regions. He had a history of a blunt trauma to the left lower quadrant of the abdomen, caused by a wooden block springing from a press machine seven days before. There were no pathological signs in his first evaluation but at the radiological scanning after 16 hours, free air was detected under the left diaphragm. In the abdomen, CT dextrocardia, situs inversus totalis and minimal free liquid near the caecum was found. At laparotomy, a 0.5 cm perforation was observed, localised at the distal ileum and the appendix was oedematous and hyperaemic, consistent with acute inflammation. Resection of the injured bowel and appendectomy were performed. At the pathological examination, the perforation area was non-specific and peri-appendicitis was found. Conclusion : Delayed postraumatic perforation of the intestine occurs as a result of ischaemia. There is no reported case of a patient with situs inversus totalis. If acute abdomen is the case even with a history of minimal abdominal trauma, delayed intestinal trauma should be considered in the diagnosis. Peri-appendicitis secondary to intestinal perforation, which is a rare condition, should come to mind at the diagnosis.