Double isolated asynchronous duodenal perforation due to abdominal blunt trauma in a child: A case report

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This is the first case described in literature of a double asynchronous isolated perforation of the duodenum.

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Timing of diagnosis and treatment are described.

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Radiologic findings are provided.

Background

Isolated duodenal perforation following blunt abdominal trauma is a rare injury in children. Bicycle accidents (falling on to the handlebar) are a frequent cause of blunt abdominal trauma in children and may occasionally be associated with isolated duodenal perforation (IDP). Prompt diagnosis and surgical treatment are vital to prevent increased morbidity and mortality.

Case presentation

We report the rare case of an 11-year-old boy admitted for blunt abdominal trauma and treated for an asynchronous double IDP. The first perforation, located on the 2nd/3rd portion of the duodenum, was promptly diagnosed by contrast-enhanced abdominal CT scan after a negative US scan, five hours after injury, and the lesion repaired with a single stitch suture. The second duodenal perforation appeared in the duodenal bulb as a worsening biliary leakage, 48 h after the primary suture of the initial lesion. The perforation was initially seen by digestive endoscopy and sutured in the same way as the first lesion. A third laparotomy was needed 4 days later due to an intestinal obstruction, after which the patient was recovered completely and was discharged home.

Discussion and conclusion

IDP is a rare consequence of blunt abdominal trauma, and is normally associated with a lesion of other organs, such as the pancreas or bile duct. A delayed diagnosis strongly increases the incidence of morbidity and mortality, and different kinds of surgical management have been proposed, depending on the type of lesion. To our knowledge, this is the first case described in literature of a double isolated asynchronous duodenal perforation following blunt abdominal trauma in children.

Multiple hereditary trichoepithelioma and cylindroma (Brooke-Spiegler syndrome)

Three cases of trichoepithelioma associated with cylindroma (Brooke-Spiegler syndrome) in the same family are reported. Three generations were affected. The syndrome usually beginning at puberty is inherited as an irregular autosomal dominant trait.