Jejunal perforation secondary to dog bite: A case report

Abstract

Dog bites commonly result in soft tissue injuries and infections, but rarely cause intestinal perforation. A 9-year-old male presented with abdominal distension and vomiting three days after being bitten in the abdomen by a stray dog. He was not evaluated immediately after the injury. One day later he developed abdominal distension, difficulty passing stool and gas, non-projectile vomiting, and intermittent high-grade fever. Two days after these symptoms began, he visited a local health center where he was started on antibiotics and was referred to our hospital for further care. On arrival, he was febrile, tachycardic, tachypneic, irritable, had a normal oxygen saturation and a Glasgow Coma Scale of 15. Abdominal examination revealed distension, diffuse tenderness, absent bowel sounds, and visible bite marks in the left lumbar and iliac regions. Blood tests were normal. A plain abdominal X-ray showed pneumoperitoneum. Suspecting a bowel perforation, the patient was taken to the operating room for an exploratory laparotomy. Approximately 200 ml of pus were found in the peritoneal cavity, along with a pinpoint jejunal perforation 30 cm from the ligament of Treitz, and a serosal tear 3 cm distal to it. The involved jejunal segment was resected, followed by a primary end-to-end jejunal anastomosis. Oral feedings were initiated on postoperative day four. The recovery was uneventful and at the two-week follow-up, he was in good health. Intestinal perforation following a dog bite, although rare, should be considered in patients presenting with abdominal symptoms after such injuries.