Retroperitoneal rupture of the duodenum due to blunt non-penetrating abdominal trauma

An Isolated Perforation of the Fourth Part of the Duodenum Following Blunt Abdominal Trauma: A Case Report

An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a 13-year-old male patient who presented to the hospital with an alleged history of being run over in the abdomen by a vehicle and a complaint of severe abdominal pain. Radiography of the abdomen in the standing position showed air under the diaphragm, and ultrasonography revealed free fluid in the pelvic and peritoneal cavities, clinching the diagnosis of hollow viscus perforation. The patient was resuscitated and underwent an exploratory laparotomy under general anesthesia. On exploration, no perforation was found in the intraperitoneal organs. The retroperitoneum was opened, and the Cattell-Braasch maneuver was used to approach the duodenum. A single perforation was discovered in the fourth part, and a modified graham patch repair was done. As soon as the patient's bowel sounds returned, a low-fat diet was started through a nasojejunal tube placed distal to the perforation site. The patient was discharged in good condition and is doing well with regular follow-ups. This case emphasizes the need for a high index of suspicion for gut perforation of both intra- and retroperitoneal organs after blunt trauma. This will help in early diagnosis and timely management to reduce perforation-associated mortality. Damage control surgery, with primary closure of the perforation, is well-suited and preferred in an emergency and resource-limited setting.

Small Bowel Perforations: What the Radiologist Needs to Know

The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes and the different direct and indirect imaging signs of small bowel perforation.

Pneumoretroperitoneum

Pneumoretroperitoneum is rare, but sometimes seen in association with pneumoperitoneum as a result of barotrauma to the lungs. However, there have only been two previous cases of pneumoretroperitoneum without pneumoperitoneum following barotrauma. This case discusses several of the possible mechanisms by which this could occur and what associated signs, especially on chest X-ray, one should look for to confirm the aetiology of gas in the retroperitoneal space.

Radiology of blunt abdominal trauma

Blunt abdominal trauma can produce injury to any of the intra-abdominal organs. While diagnostic studies may be necessary to help determine the most appropriate therapy, all these procedures take time, which in some instances can be better used to treat the patient actively. The condition of the patient and the clinical findings take precedence in the handling of the injured patient. Certain skeletal injuries are often a first clue and can help focus further investigations. Plain films and regular contrast examinations are adequate to evaluate most intra-abdominal injuries. When time is available, a variety of other radiologic techniques are available in most hospitals. Nuclear imaging is of considerable value in studying the liver, spleen, and kidneys. Thus far, ultrasound techniques have left much to be desired although theoretically of considerable potential. Angiography can be of great diagnostic and potentially of some therapeutic value. No diagnostic test beats a good history and careful examination. Radiologic studies, ideally, should be done to confirm a clinical suspicion, not just for the sake of "completeness."

Traumatic retroperitoneal rupture of the duodenum

A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene. Plain X-ray and Gastrografin studies may help to elucidate the situation in particular cases, but are no substitute for repeated careful abdominal examination. It is suggested that large doses of penicillin be employed where possible in the management of these cases, in addition to such antibiotic therapy as may be expected to be effective against the usual Gram-negative bowel flora.

Rupture of the Duodenum Produced by a Safety Belt

The case report of a patient who sustained a traumatic rupture of the first part of the duodenum as a result of the restraint produced by a seat belt is presented. The literature on closed rupture of the duodenum is reviewed, and the possible mechanism of injury is discussed.

SUMMARY

A case of closed rupture of the first part of the duodenum as the result of injury due to the restraint produced by a safety belt is presented. The literature on closed rupture of the duodenum and seat belt injuries is briefly reviewed. The possible mechanisms of injury to the duodenum are discussed. The considered evidence in this case suggests that the body was thrown on to the loose safety belt, sustaining a blow to the right hypochondrium during a period in which the duodenum was distended, with the consequent production of explosive rupture of its first part.