Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review

Abstract

Background Gastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify. Case presentation A young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass. Conclusions Assessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival.

To Observe the Treatment Outcomes of Duodenal Injury in Penetrating and Blunt Trauma Patients

“…19,20 In a similar study reported by Lai the duodenal injuries have high morbidity and mortality rates (5.3%-30%, respectively). 8 A study done by Bashir the mortality rate was 10-30%. 21 The morbidity and mortality depends on factors such as severity of chest injury, condition of the underlying lungs, associated extra-thoracic injuries especially to head, abdomen and long bones.…”

“…Duodenal fistulas are serious complication with morbidity. The recent reports reveal a significant improvement in morbidity and mortality of duodenal injury and with traumatic gastrointestinal injury 8 . The past incidence is still relatively high with an overall morbidity rate of 50 to 60% and mortality rate of 0-7%.…”

“…This management purpose is to prevent duodenal fistula which is a serious complication of mortality 7 . The most of duodenal wounds of blunt trauma can be successfully treated by simple suture repair and few patients require some other operations to protect the repaired duodenal suture line or to make the leakage 8 . Various other procedures have been advocated since the beginning of the 20 th century and among them, pyloric exclusion is currently one of the most widely used methods 9 .…”

Indicacoes Da Laparotomia Exploratória No Manejo De Pacientes Vitimas De Trauma Abdominal Contuso E Penetrante

“…De acordo com dados, os traumas abdominais contusos são mais comuns do que os penetrantes, sendo 80% dos traumas abdominais vistos em pronto-socorro ocasionados por mecanismo de trauma fechado e 1/3 destes ocasionados por acidentes de trânsito. Quanto aos órgãos afetados, fígado e baço são os mais comumente lesionados, com taxas de incidência de 0,81-30,1% de lesões gastrointestinais, 0,1% estomacais e 0,4% duodenais (AKEEL et al, 2021;LAI, et al, 2020).…”

Epidemiological Features and Intra-operative Pattern of Gastrointestinal Tract Injury: a Single Center, Descriptive Study.

“…Duodenal perforation occurred in eight out of ten patients, while SMT/WHs were detected in only two individuals. Duodenum is located retroperitoneally adjacent to the vertebral and is more infrequent among adult populations than children (22).…”