POST TRAUMATIC RETROPERITONEAL DUODENAL PERFORATION

Abstract

Duodenal injury is less common after
blunt injury abdomen. Blunt injury constitutes
22 percentage of all duodenal injuries.
It constitutes 3-5 percent of all abdominal
injuries. Most common in the
second and third portions. Usually accompanied
by other intra abdominal injuries.
There are various treatment for duodenal
injuries according to grading.
Treatment consists of simple suturing to
whipples procedure. Here we report a
case of duodenal injury who presented
with abdominal pain, vomiting, fever and
abdominal distension after blunt injury
abdomen for 2 days. On examination patient
is dehydrated, febrile, vitals stable.
Abdomen distended, generalised tenderness,
guarding, rigidity present. Free
fluid present. Blood investigations normal
except Hb-10.8 gram per deciliter. Serum
amylase and lipase normal. Four quadrant
aspiration positive. Plain x ray abdomen
and contrast enhanced CT scan
confirmed the diagnosis and showed
retroperitoneal pneumoperitoneum.
Laparotomy done, patient had
perforation in D2, D3 junction in the posterior
wall. Patient was treated successfully
by suturing the perforation in two layers,
duodenal diverticulization with Billroth II anastomosis,
jejunojejunostomy and feeding
jejunostomy. Post operative events uneventful.
Patient is under regular follow up.
To conclude, any bile staining in the peripancreatic
area should be explored, both
the Kocher manoeuvre and the Cattell-
Braasch exposure is essential. Duodenal
injury usually has late presentation, so
early diagnosis and treatment can prevent
morbidity and mortality.