An uncommon case of lucid Interval- bowel perforation

Abstract

Hollow viscus injuries (HVI) following blunt abdominal trauma are rare and diagnostically challenging, especially when early signs are absent or minimal. We report the case of a 17-year-old male who presented 24 hours after a bicycle handlebar injury with two episodes of vomiting and no abdominal tenderness or peritoneal signs. Initial imaging, including E-FAST and plain abdominal radiography, was unremarkable. During a period of observation, isolated tachycardia developed, prompting contrast-enhanced computed tomography (CE-CT), which revealed free fluid in Morrison’s pouch, paracolic gutters, pelvis, and intermesenteric spaces without solid organ injury. Based on imaging and clinical suspicion, diagnostic laparoscopy was performed, revealing a 2.5 × 2.5 cm jejunal perforation approximately 15 cm distal to the duodenojejunal flexure along with an associated mesenteric rent. Both defects were repaired laparoscopically. The patient’s postoperative recovery was uneventful, and he was discharged on postoperative day nine. This case highlights the diagnostic difficulty posed by the “lucid interval” phenomenon—where early clinical and imaging findings appear benign despite underlying bowel injury. It emphasizes the importance of continuous monitoring and low threshold for advanced imaging when subtle physiological changes occur. Furthermore, it demonstrates the feasibility and efficacy of minimally invasive surgery in managing isolated jejunal perforations in stable patients. Early detection and timely intervention are essential to prevent morbidity and improve outcomes in patients with blunt abdominal trauma and suspected hollow viscus injury.