Intestinal perforation due to minor blunt abdominal trauma–a harbinger of underlying disease pathology

When a patient suffers a blunt intestinal injury after a low-energy mechanism, be prepared to find a pathologic area in the bowel. We present the case of a previously healthy 13-year-old female who presented complaining of abdominal pain hours after impact with the safety bar of an amusement park ride. Upon operative exploration, she was found to have extensive inflammation of the distal ileum including the ileocecal valve with creeping mesenteric fat and a full-thickness perforation of the inflamed segment. An ileocecectomy and primary anastomosis were performed. Pathology confirmed the presence of Crohn's disease. This case is the first reported incidence of a traumatic perforation leading to a diagnosis of pediatric Crohn's disease. Blunt perforation of the bowel following a low-impact mechanism should heighten the suspicion of an underlying disease process.