Isolated Duodenal Perforation at D3 Following Blunt Abdominal Trauma, a Challenging Diagnosis and Management: A Case Report

Abstract

Introduction: Isolated duodenal rupture following blunt abdominal trauma is rare. We here report a case of isolated duodenal perforation treated by suture, pyloric exclusion and side-to-side gastrojejunostomy in order to discuss its diagnostic, therapeutic, and evolutionary features. Observation: A 46-year-old man, victim of a physical aggression, consulted ten hours after the trauma for diffuse abdominal pain associated with vomiting. The physical examination revealed a febrile patient at 38.2°C, hemodynamically stable with generalized abdominal defense. The abdominal CT revealed parietal defect of the 3rd duodenum (D3), pneumoperitoneum, intra and retroperitoneal fluid effusion without adjacent organ involvement. The patient underwent emergency surgery. Intraoperatively, a centimetric perforation of D3 on the anterior wall was found. The lacerated edges were repaired with interrupted sutures. A pyloric exclusion and side- to-side gastrojejunostomy are performed. Postoperative course of patient was unremarkable. Isolated duodenal injuries are rares in blunt abdominal trauma because the duodenum is located in a deep anatomical position. Duodenal injuries secondary to blunt trauma can range in severity from intramural hematoma to a complete transection and devascularization of the duodenum. There is no consensus on the surgical procedure. Options range from primary suture to complex duodenopancreatic resections based on the severity of the lesions. Conclusion: Isolated duodenal trauma is unusual following blunt trauma. Prompt diagnosis and management is the key to prevent morbidity and mortality.