Reconstruction of a traumatic duodenal transection with a pedicled ileal loop: a case report

Abstract

IntroductionBlunt duodenal injuries do not occur often. A patient with damage to the duodenal tissue around the pancreatic and common bile duct presents a challenge to surgeons. The choice of procedure must be tailored to the nature of the defect and the amount of tissue lost.Case presentationWe describe the case of a 16-year-old Caucasian boy with a blunt duodenal injury after a motor vehicle accident. On admission, the patient had stable vital signs and a normal laboratory workup. Gradually his clinical condition deteriorated and a computed tomography scan showed a retroperitoneal haematoma at the level of his duodenum. A fully circumferential rupture of the second part of his duodenum was found during laparotomy, with the intact Vater's papilla lying adjacent to the defect and a superficial laceration of the head of his pancreas. The retroperitoneal haematoma was thoroughly drained and a pedicled ileal loop was interposed between the duodenal stumps to restore the continuity of the patient's duodenum. Apart from a mild postoperative pancreatitis, the patient's postoperative course evolved with no further problems. The patient was discharged on the 22nd postoperative day in excellent condition and has remained so to date (after five years).ConclusionIn our case report, where the second part of the patient's duodenum was completely transected, our choices for reconstruction were limited. Important factors for the successful management of this patient were prompt surgical intervention and the accurate assessment of the nature of the duodenal and associated injuries. We believe that the technique we used was a reasonable choice because the anatomical continuity of the patient's duodenum was restored.

An Unusual Case of Devastating Isolated Duodenal Injury treated by Emergency Whipple’s Procedure: Possible Explanation

“…The range of procedures includes drainage alone, insertion of pancreatic duct stent through ERCP, distal pancreatectomy with or without splenectomy, pancreatectojejunostomy and at the end of the scale, pancreatoduodenectomy [9]. Although the diagnosis may be difficult, the presence of retroperitoneal haemtoma [8] or air [5] in the region of the duodenum on CT scan, is highly suggestive of duodenal injury, as was seen in our patient.…”

“…For duodenal injuries, debridement and suture repair [3][4][5][6] with or without pyloric exclusion have been utilized with success [7]. Cases with substance loss have been managed by pedicled ileal loop to bridges duodenal defects [8]. Additionally, duodenal diverticulization and triple tube technique have proved useful tools in the surgeon's armamentarium.…”

Isolated rupture of duodenum following blunt trauma abdomen: report of a case of avulsion of pylorus

“…Pedicled ileal loop might have been interposed between the duodenal stumps to restore the continuity of the patient's duodenum. 4 But we did primary closure of disrupted ends with omental patch support along with a feeding jejunostomy (Figure 2). The patient was transferred to intensive care unit for continuous monitoring of vitals.…”

“…3 The choice of treatment, must be covered to the nature of the defect and the amount of tissue lost. 4 Different surgical techniques have been developed for the management of patients with duodenal injuries. 4 The surgeon should select the most efficient procedure according to the type and conditions of the patient's injury.…”

“…4 Different surgical techniques have been developed for the management of patients with duodenal injuries. 4 The surgeon should select the most efficient procedure according to the type and conditions of the patient's injury. 5 Study describe case report of a patient with a complete transection of the first part of duodenum with avulsion of pylorus, resulting from a blunt abdominal injury.…”