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McCague A, Patterson B, Taggart T. Management of Complex Duodenal Injuries After Penetrating Trauma. Cureus 2023; 15:e40431. [PMID: 37456438 PMCID: PMC10348394 DOI: 10.7759/cureus.40431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Penetrating injuries to the duodenum can present a complex case for trauma or acute care surgeons. The associated injuries and complications can have devastating results. This report presents the case of a 41-year-old male who presented with a gunshot wound to his abdomen and suffered a gastric injury, transverse colon injury, duodenal injury, renal injury, and pancreatic tail injury. In this case, the patient underwent a complex Roux-en-Y reconstruction. The patient had a good outcome and continues to recover at home.
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Affiliation(s)
- Andrew McCague
- Trauma, Desert Regional Medical Center, Palm Springs, USA
| | | | - Tracy Taggart
- Trauma, Desert Regional Medical Center, Palm Springs, USA
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Gunarathne KPDJK, Kaushalya PDJ, Halpegamage NW. A delayed presentation of a traumatic isolated duodenal injury. SAGE Open Med Case Rep 2023; 11:2050313X231169848. [PMID: 37151739 PMCID: PMC10154991 DOI: 10.1177/2050313x231169848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Blunt injury to the abdomen resulting in isolated duodenal injury is rare in surgical practice. Due to the insidious onset of symptoms and the vague non-specific nature of the clinical presentation, these injuries can be easily missed even in experienced hands. Contrary to Europe or developed countries, assaults to the abdomen using hands, fists, and feet in home-based violence is common in third-world countries. These patients have the habit of hiding the assault part of the history to avoid litigations to 'known' people. A high level of suspicion, a continuous revisiting of the history, and timely damage control surgery can improve the outcomes of such patients.
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Affiliation(s)
- KPD Janitha Kaushalya Gunarathne
- National Hospital Colombo, Colombo, Sri
Lanka
- KPD Janitha Kaushalya Gunarathne, National Hospital
Colombo, Colombo 0800, Western Province, Sri Lanka.
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Kumar S, Panda SS, Neogi S, Ratan SK, Kumar A. Triple Diversion Technique in Complete Duodenal Transaction Following Blunt Trauma Abdomen: A Time-Tested Method in a Very Rare Injury. J Indian Assoc Pediatr Surg 2022; 27:245-247. [PMID: 35937121 PMCID: PMC9350657 DOI: 10.4103/jiaps.jiaps_284_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/25/2020] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Duodenal injury following blunt abdominal trauma is extremely rare in children and many times, it has delayed presentation, leading to increased morbidity and mortality. A patient with complete duodenal transaction is a surgical challenge and management involves the time of presentation and extent of visceral damage. A 10-year-old boy was brought with features of bowel perforation after road traffic accident and underwent emergency laparotomy which revealed complete transaction of duodenum at D1 and D2 and pyloroduodenal junction extending toward lesser curvature. Primary closure of pyloroduodenal junction and D1-D2 was done with omental patch along with triple tube decompression (cholecystostomy, gastrostomy, and jejunostomy). The patient had an uneventful recovery. Primary closure of disturbed ends with triple diversion is a safe approach in young children with complete duodenal transaction in absence of gross peritoneal contamination and early presentation.
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Affiliation(s)
- Shishir Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India,Address for correspondence: Dr. Shasanka Shekhar Panda, Department of Paediatric Surgery, Maulana Azad Medical College, New Delhi - 110 002, India. E-mail:
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Ashish Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Shah T, Raj Joshi B, Kumar A, Simkhada G, Kumar Gupta R. Isolated duodenal injury presenting as Fournier's gangrene: A case report. Clin Case Rep 2021; 9:e04232. [PMID: 34188923 PMCID: PMC8218324 DOI: 10.1002/ccr3.4232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Isolated duodenal injury is rare as they are usually associated with other visceral injuries. Diagnosis of a duodenal injury is difficult, and its management is challenging. Hence, it is important to timely recognize such injuries for better outcome.
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Affiliation(s)
- Tuhin Shah
- Department of SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Brikha Raj Joshi
- Department of SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Abhijeet Kumar
- Department of SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Ganesh Simkhada
- Department of SurgeryB P Koirala Institute of Health SciencesDharanNepal
| | - Rakesh Kumar Gupta
- Department of SurgeryB P Koirala Institute of Health SciencesDharanNepal
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Tokumaru T, Eifuku R, Sai K, Kurata H, Hata M, Tomioka J. Pediatric blunt abdominal trauma with horizontal duodenal injury in school baseball: A case report. Medicine (Baltimore) 2021; 100:e24089. [PMID: 33466171 PMCID: PMC10545394 DOI: 10.1097/md.0000000000024089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pediatric sports injuries, including those from baseball, most often are musculoskeletal injuries and rarely include blunt abdominal injuries. Duodenal injury is rare and often associated with other organ injuries. Because it has a relatively high mortality, early recognition and timely treatment are needed. Here, we report a case of successful treatment of a pediatric patient with duodenal injury incurred in the context of school baseball. PATIENT CONCERNS A 13-year-old boy suffered blunt abdominal trauma and a right-hand injury caused by beating his abdomen strongly with his own right knuckle after he performed a diving catch during a baseball game. On the following day, the abdominal pain had worsened. DIAGNOSES Computed tomography led to a suspicion of injury to the horizontal part of the duodenum. INTERVENTIONS The duodenal injuries were repaired by simple closure. On the 10th post-operative day, an abscess formed in the retroperitoneal cavity because of an occult pancreatic injury. Ultrasound-guided percutaneous drainage of the cavity was performed. OUTCOMES The post-operative course of the abscess drainage was uneventful. The patient was discharged from our hospital on day 72 after admission and was in good health at the 9-month follow-up. LESSONS Regardless of the type of injury, we must assess the life-threatening conditions that can be expected based on the mechanism of the injury. In duodenal injuries, it is critical to perform surgical procedures and post-operative management based on the assumption of injuries to other organs.
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Mendoza-Moreno F, Furtado-Lobo I, Pérez-González M, Díez-Gago MDR, Medina-Reinoso C, Díez-Alonso M, Hernández-Merlo F, Noguerales-Fraguas F. Duodenal Rupture after Blunt Abdominal Trauma by Bicycle Handlebar: Case Report and Literature Review. Niger J Surg 2019; 25:213-216. [PMID: 31579380 PMCID: PMC6771178 DOI: 10.4103/njs.njs_31_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Blunt abdominal trauma is most frequent in the pediatric population. Duodenal lesions after abdominal trauma in children are infrequent and tend to be secondary to traffic accidents. It is up to five times more frequent in males, with an average age between 16 and 30 years. Bicycle accidents continue to lead to morbidity and mortality in children, representing between 5% and 14% of total blunt abdominal injuries. The diagnosis of duodenal injuries after trauma is difficult and requires a high index of clinical suspicion. We present the case of a 17-year-old patient seen in the emergency room after falling off his bicycle and presented a blunt trauma in the epigastric region. On physical examination, there was a swelling in the upper right abdominal quadrant and epigastrium with tenderness on deep palpation. He presented with hematemesis without hemodynamic repercussion. A contrast abdominal computed tomography was performed and he was diagnosed with third-part duodenal rupture. A resection of the perforated third-part duodenal rupture was performed, and the transit was reconstructed using a Roux-Y duodenojejunostomy. The postoperative period was uneventful and the patient was discharged after 16 days of stay. Duodenal injury is very rare, produced by high-energy trauma. They rarely present as single lesions as other visceral lesions are usually associated. The early diagnosis is important to reduce the morbidity and mortality.
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Affiliation(s)
- Fernando Mendoza-Moreno
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Isabel Furtado-Lobo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Marina Pérez-González
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Maria Del Rocío Díez-Gago
- Department of Emergency Medicine, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Carlos Medina-Reinoso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Manuel Díez-Alonso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Francisco Hernández-Merlo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Fernando Noguerales-Fraguas
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
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Jędrzejczak B, Bednarski P, Spychalski M, Lipiński P, Dziki A, Mik M. Endoscopic management of duodenal fistula in a patient operated after abdominal injury. Pol Przegl Chir 2019; 92:64-67. [PMID: 32312916 DOI: 10.5604/01.3001.0013.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Post-traumatic duodenal injuries constitute a relatively rare group among this type of lesions reported in the abdominal structures. In the vast majority of cases, a post-traumatic duodenal injury is accompanied by damage to other important organs. The surgical management of duodenum injuries poses a high risk of life-threatening complications with duodenal fistula among the most common. In some cases, the combination of basic and advanced surgical procedures and intensive conservative treatment is insufficient to treat the complication. The progress in endoscopic techniques and the application of modern instruments have allowed for the use of these procedures to manage gastrointestinal injuries of various aetiology. The aim of the study is to present an effective endoscopic occlusion of post-traumatic duodenal fistula.
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Affiliation(s)
- Bartłomiej Jędrzejczak
- Oddział Chirurgiczny z Pododdziałem Chirurgii Onkologicznej, Szpital Specjalistyczny Brzeziny
| | - Piotr Bednarski
- Oddział Chirurgiczny z Pododdziałem Chirurgii Onkologicznej, Szpital Specjalistyczny Brzeziny
| | - Michał Spychalski
- Oddział Chirurgiczny z Pododdziałem Chirurgii Onkologicznej, Szpital Specjalistyczny Brzeziny
| | | | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Michał Mik
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
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Weale RD, Kong VY, Bekker W, Bruce JL, Oosthuizen GV, Laing GL, Clarke DL. Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa. Scand J Surg 2019; 108:280-284. [PMID: 30696350 DOI: 10.1177/1457496918822620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The management of duodenal trauma remains controversial. This retrospective audit of a prospectively maintained database was intended to clarify the operative management of duodenal injury at our institution and to assess the risk factors for leak following primary duodenal repair. MATERIALS AND METHODS This was a retrospective study undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa. Operative techniques used for duodenal repair were recorded. Our primary outcome was duodenal leak in the postoperative period. Patients from January 2012 to December 2016 were included. All duodenal injuries were graded according to the American Association for the Surgery of Trauma (AAST) grading. Only patients who had a primary repair were included in the final analysis. RESULTS During the five-year data collection period, a total of 562 patients underwent a trauma laparotomy; of which 94 patients sustained a duodenal injury. A primary pyloric exclusion and gastro-jejunostomy (PEG) was performed in three patients. These three were then excluded from further analysis. Of the 91 primary duodenal repairs, seven (8%) subsequently leaked. These were managed by PEG in three and by secondary repair and para-duodenal drainage in four. The two physiological parameters most associated with subsequent leak were lactate and pH level. There was a significantly higher mortality rate for those who leaked vs those who did not leak. Chi-squared test revealed a significant difference in the leak rate between AAST I (0%), AAST-II (1.6%) and AAST-3 (66.7%) grade injuries (p <0.01). CONCLUSION The trend towards primary repair of duodenal injuries appears to be justified. However duodenal leak remains a significant risk in certain high risk patients and strategies to manage injuries in this subset requires further work.
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Affiliation(s)
- R D Weale
- Department of Surgery, North West Deanery, Manchester, United Kingdom
| | - V Y Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - W Bekker
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J L Bruce
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G V Oosthuizen
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G L Laing
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - D L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
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Torba M, Gjata A, Buci S, Troci A, Subashi K. Delayed presentation of blunt duodenal injuries in children. Case report and review of literature. G Chir 2013; 34:122-124. [PMID: 23660164 PMCID: PMC3915581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. CASE REPORT A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm³. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. CONCLUSION Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.
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Affiliation(s)
- M Torba
- National Trauma Center, University Central Military, Trana, Albania, Italy
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Abstract
BACKGROUND/AIM Duodenal injury is an uncommon finding, accounting for about about 3-5% of abdominal trauma, mainly resulting from both penetrating and blunt trauma, and is associated with significant mortality (6-25%) and morbidity (30-60%). PATIENTS AND METHODS Retrospective analysis was performed in terms of presentation, management, morbidity and mortality on 14 patients of duodenal injuries out of a total of 172 patients of abdominal trauma attending Subharti Medical College. RESULTS Epigastric pain (100%) along with vomiting (100%) is the usual presentation of duodenal injuries in blunt abdominal trauma, especially to the upper abdomen. Computed tomography (CT) was diagnostic in all cases. Isolated duodenal injury is a rare finding and the second part is mostly affected. CONCLUSION Duodenal injury should always be suspected in blunt upper abdominal trauma, especially in those presenting with epigastric pain and vomiting. Investigation by CT and early surgical intervention in these patients are valuable tools to reduce the morbidity and mortality.
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Affiliation(s)
- Sanjay Pandey
- Department of Surgery, Subharti Medical College, Meerut, India.
| | | | - Shashank Mishra
- Department of Surgery, Subharti Medical College, Meerut, India
| | - Tarun Agrawal
- Department of Surgery, Subharti Medical College, Meerut, India
| | | | - Akhil Prakash
- Department of Surgery, Subharti Medical College, Meerut, India
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