A RARE CASE OF DUODENAL INJURY FOLLOWING BLUNT TRAUMA ABDOMEN

Abstract

Duodenal injury can pose a formidable challenge to the          surgeon. The total amount of fluid passing through the           duodenum can exceed 61 litres per day and failure to properly manage the duodenal injury can result in fistula causing           serious fluid and electrolyte imbalance. The retroperitoneal location of the duodenum and its close proximity to other viscera like CBD, Pancreas, major vascular structures means that the isolated duodenal injury(1,8) itself is rare following blunt trauma abdomen. It represents nearly 3 to 5 of patients with blunt injury abdomen and often occurs after blows to upper abdomen. Blunt injury(1,8) of the duodenum is most commonly caused by the transmittal of significant force to the anterior abdomen, as often experienced by an unrestrained driver in a motor vehicle accident who comes into contact with the steering wheel. A considerable number of blunt duodenal injuries(1,8) can, however be caused by far less violent mechanisms such as falls, assaults, and handlebar contact. We had a case of blunt injury abdomen with duodenal rupture following hit with steering wheel which was managed by emergency laparotomy, tube duodenostomy, diversion posterior gastrojejunsostomy and feeding jejunostomy.