A 29-year-old male presented to the emergency department following a motorcycle accident, exhibiting pallor, tachycardia (110 beats/min), and hypotension (90/60mmHg). A rigid abdomen raised suspicion of peritonitis. A focused assessment with sonography for trauma (FAST) revealed moderate free fluid, while an erect chest X-ray showed no pneumoperitoneum. CT with intravenous contrast identified a grade 2 splenic injury with multiple lacerations (<3cm), leading to conservative management as no bowel perforation was evident. Despite initial stabilization, the patient’s condition worsened over four days, with severe abdominal pain, generalized peritonitis, and rigidity. Given his clinical deterioration, an exploratory laparotomy was performed, revealing 400mL of hemoperitoneum and intestinal content contamination. A 1cm jejunal perforation, located 15cm from the duodenojejunal junction, was identified and repaired with a 6cm segmental resection and hand-sewn end-to-end anastomosis. The splenic injury progressed to active bleeding with hilar involvement, necessitating a splenectomy. Hemostasis was secured, and a peritoneal lavage was performed. Two abdominal drains were placed for postoperative monitoring. The absence of pneumoperitoneum on initial imaging delayed the diagnosis of hollow viscus injury, highlighting the limitations of plain radiographs. The lack of oral contrast in CT further contributed to missed detection. Studies suggest that triple-contrast CT (IV, oral, and rectal) improves diagnostic accuracy for bowel injuries. Serial clinical examinations remain crucial, as timely surgical intervention is essential in deteriorating trauma patients. The patient was managed postoperatively in the ICU before transitioning to the surgical ward. He was mobilized early, enteral feeding was initiated, and vaccinations were scheduled to prevent overwhelming post-splenectomy infection (OPSI). He was discharged on postoperative day seven. This case emphasizes the need for multimodal imaging and high clinical suspicion in blunt abdominal trauma.

Keywords: Blunt abdominal trauma, Diagnostic imaging, Exploratory laparotomy, Hollow viscus injury, Jejunal perforation