Isolated duodenal perforation in children: Importance of high index of suspicion following blunt trauma abdomen

Abstract

Introduction Isolated duodenal perforation (IDP) is rare and only isolated cases are reported in the literature. Due to its rarity and subtle presentation, the diagnosis of IDP is often delayed. Delay in the diagnosis and surgical intervention result in increased morbidity and mortality. The aim of this article is to highlight the importance of a high index of suspicion of IDP following blunt abdominal trauma and safety of primary repair without diversion in such cases. Material and methods Children with isolated duodenal injuries following blunt abdominal trauma were included; mode of trauma, clinical presentation, diagnosis, operative intervention and outcome were studied. Results Nine patients with isolated duodenal perforations were identified and operated on. Most had minimal clinical findings on arrival and were haemodynamically stable. Abdominal radiography and ultrasonography were unremarkable. However, pain remained persistent and worsening of vomiting was seen over time. Contrast-enhanced computed tomography (CECT) of the abdomen with oral and intravenous contrast was done to identify the injuries. Primary repair of perforation was performed in all cases. The most common cause was road traffic accident. There were three Grade 2 injuries, five Grade 3 and one Grade 4 injuries. Eight patients healed well with uneventful recovery – one patient died from sepsis after presenting 24 h after injury with frank peritonitis. Conclusion Isolated duodenal perforation presents without specific signs and symptoms and a high index of suspicion is necessary for early diagnosis. Contrast-enhanced computed tomography of the abdomen with oral contrast should be ordered early if symptoms persist or worsened over time.