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A healthy 6-year-old boy presented to the emergency department after experiencing a bicycle handlebar injury. He complained about abdominal pain and had vomited twice. At physical examination, according to the Advanced Pediatric Life Support protocol, he had normal vitals results with pain during palpation of the left abdominal region without guarding. His hemoglobin level was 12.3 g/dL (to convert to grams per liter, multiply by 10) (normal value, 10.5-16.1 g/dL), amylase 68 U/L (to convert to microkatals per liter, multiply by 0.0167) (normal value, <85 U/L), and lipase 25 U/L (normal value, <60 U/L). A plain chest radiography result showed no signs of traumatic injury. Abdominal ultrasonography results showed a bowel loop with a thickened wall in the left abdominal region with no free abdominal fluid. He was admitted to the pediatric ward for close observation. The next day, his vomiting persisted, especially after oral intake. Computed tomography with oral and intravenous contrast was performed (Figure 1).
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C. Intramural small-bowel hematoma
The computed tomography scan showed an intramural small-bowel hematoma with a complete bowel obstruction and no signs of perforation. Because of his persistent vomiting, the patient initially received a nasogastric tube. All oral intake immediately resulted in nausea that was relieved by nasogastric tube drainage. Because of the persistent vomiting, the patient underwent a laparotomy 2 days posttrauma, at which the diagnosis of a traumatic intramural jejunal hematoma with complete luminal obstruction was confirmed. The injured jejunal segment was resected, followed by an end-to-end anastomosis (Figure 2). The postoperative course was uncomplicated and his oral intake could be reinstated 2 days postsurgery.
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Corresponding Author: Jurriën Stiekema, MD, PhD, Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Center & Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands (firstname.lastname@example.org).
Published Online: December 6, 2017. doi:10.1001/jamasurg.2017.4930
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s mother for granting permission to publish this information.
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