Ruptured Viscus Causes and Complications

Traumatic Causes

• Small bowel and colon injuries occur in approximately 1% of blunt trauma cases, with the jejunum being the most commonly affected segment (Grade II-III injuries in 13.33% of cases) 1
• Hollow viscus injuries occur in approximately 17% of penetrating trauma cases 1
• The presence of a seatbelt sign should raise high suspicion for bowel injury and warrants CT imaging 2

Non-Traumatic Causes

• Perforated duodenal ulcer is a classic cause of secondary peritonitis from loss of gastrointestinal tract integrity 3
• Gangrenous appendicitis can lead to perforation and secondary peritonitis through direct invasion 3
• Diverticular perforation represents another common source requiring surgical source control 3
• Anastomotic dehiscences are common causes of secondary peritonitis in the postoperative period 3

Associated Visceral Structures

• Mycotic aneurysms of visceral arteries (superior mesenteric, hepatic, renal) can rupture into the gastrointestinal tract, causing catastrophic hemorrhage 4, 5
• Aortoenteric fistulae occur in up to 4% of patients following abdominal aortic aneurysm repair, representing communication between the aorta and bowel 4

Clinical Pitfalls

• CT alone cannot reliably exclude bowel, diaphragm, or pancreas injury in blunt trauma 6, 7
• High-risk mechanisms (handlebar injuries, seatbelt injuries) with non-specific CT findings mandate admission for serial clinical examination and inflammatory marker trending, as isolated hollow viscus perforations represent less than 1% of blunt trauma injuries but carry significant morbidity when missed 2