A rare case of D2 perforation in blunt injury abdomen

Abstract

A 47-year-old female brought by attenders to casualty with alleged history of accidental injury, struck against iron rail in bus 1 day before sustained injury in abdomen. Presented with complaints of abdominal pain, vomiting for 2 days. Previous history of duodenal ulcer - Gastric outlet Obstruction & undergone bilateral truncal vagotomy with posterior Gastrojejunostomy 1year before. She was dehydrated, hemodynamically unstable bp not recordable, pulse feeble, with upper midline healed laparotomy scar in abdomen and tenderness in upper abdomen, diffuse swelling progressively increasing in size noted in epigastric region, guarding present. Patient was resuscitated. Supine Xray abdomen showed dilated bowel loops. CT abdomen showed pneumoperitoneum, free fluid in pelvis, no solid organ injury. Patient was taken for emergency laprotomy. Intraoperatively Omental adhesions to previous scar and about 300ml of turbid fluid noted, Status postoperative posterior Gastrojejunostomy. Colon-free from injuries. Diffuse saponification noted in omentum. Bile staining present. D2 perforation of size 2×2cm noted in anterolateral aspect. Pyloric exclusion, primary closure of duodenal injury and Tube duodenostomy done. Ryles tube passed through distal limb of GJ for feeding purposes postoperatively.