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CASE REPORT
ABSTRACT
INTRODUCTION
Context Isolated blunt duodenal injury is a
rare finding associated with high morbidity Blunt duodenal injury is an uncommon
and significant mortality. The early finding associated with significant mortality
identification of a duodenal injury is usually (6 to 25%) and morbidity (30 to 60%) [1, 2,
difficult, considering the anatomical location 3]. The evidence of an isolated traumatic
of the duodenum and lack of peritoneal signs duodenal lesion is an even more rare event. In
and diagnostic delay is part of the clinical fact considering its anatomic location, lesions
picture in most cases. of the duodenum are usually associated with
pancreatic, hepatic, gastric and intra-
Case report A 43-year-old man was admitted
abdominal vascular injuries. These latter are
to our hospital after a motor vehicle collision.
responsible for the great majority of deaths in
At admission he underwent emergency
these patients [4, 5, 6].
surgery because of lower extremities
The early identification of a duodenal injury
fractures. Twelve hours later he started to
can be challenging, and the high complication
complain an increasing abdominal pain; blood
rate associated with it is partly the results of
tests showed serum amylase up to 180 U/L
misdiagnosis and diagnostic delay, which can
and a CT scan demonstrated a perforation of
lead to major septic and inflammatory
the third duodenal portion. At laparotomy a
complications [7, 8, 9].
Grade III injury of the duodenum was
Here we report a case of an isolated duodenal
evident. The laceration was sutured and a
injury with delay in diagnosis and final
“quadruple-tube” decompression was
favorable outcome, treated with “quadruple-
performed. The postoperative course was
tube” decompression.
uneventful. One year after surgery he is well
without any long-term complication. CASE REPORT
Conclusion A high degree of suspicion is A 43-year-old man was admitted to our
necessary for early diagnosis of blunt hospital after a motor vehicle collision with
duodenal trauma and CT scan should be lower extremities and abdominal trauma. At
performed in case of all significant epigastric admission he was well oriented with Glasgow
trauma. In most cases primary direct repair of coma score of 15, ventilation and saturation
duodenal wounds can be safely achieved and were within normal values as well as blood
duodenal decompression via triple or pressure and heart rate. The abdomen was soft
quadriple tube technique is required to and tender at palpation; lap belt sign and
decrease the risk of duodenal fistula. ecchymoses or lacerations were absent. Plain
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 5 - September 2007. [ISSN 1590-8577] 617
JOP. J Pancreas (Online) 2007; 8(5):617-620.
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 5 - September 2007. [ISSN 1590-8577] 618
JOP. J Pancreas (Online) 2007; 8(5):617-620.
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 5 - September 2007. [ISSN 1590-8577] 619
JOP. J Pancreas (Online) 2007; 8(5):617-620.
JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 5 - September 2007. [ISSN 1590-8577] 620