Double transection of complete duodenal circumference after blunt abdominal trauma without other intra-abdominal injuries.

ABSTRACT

We report a case of a 20-year-old male with isolated complete duodenal transection at two duodenal segments after blunt abdominal trauma. On admission, the patient underwent physical examination, laboratory analysis, abdominal ultrasound and plain abdominal x-ray. Physical examination revealed diffuse and rebound tenderness and extreme rigidity of the abdomen, guarding and decreased bowel sounds. Standard surgical techniques were used (median laparotomy, primary anastomosis, nasojejunal three-luminal tube for feeding and gastric decompression). At exploration, we found complete transection of the duodenum just below the pylorus and between the second and third part of the duodenum. We performed primary anastomosis of both transections with interrupted sutures in two layers. Prior to discharge magnetic resonance imaging (MRI) was performed. Early diagnosis of duodenal rupture is important. When dealing with trauma patients with pain greater than local findings, the mechanism of injury should always be taken into account.