Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review

Abstract Background Gastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify. Case presentation A young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass. Conclusions Assessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival.

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Isolated Cecal Rupture after Blunt Abdominal Trauma

Annals of African Surgery ◽

10.4314/aas.v17i3.11 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Alemayehu Ginbo Bedada ◽

Elijah Wade Riddle ◽

Alemayehu Bekele Eshetu ◽

Georges Azzie

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

High Speed ◽

Motor Vehicle ◽

Right Hemicolectomy ◽

Motor Vehicle Crash ◽

Hiv Positive ◽

Colon Anastomosis ◽

Hollow Viscus ◽

Superficial Wound

Cecal perforation following blunt abdominal trauma is an uncommon and challenging injury. We report a 19-year-old HIV-positive woman who presented with abdominal pain after a high-speed motor vehicle crash. Abdominal exam revealed a seatbelt sign with evidence of peritonitis; Focused Assessment with Sonography for Trauma showed free intraperitoneal fluid. After fluid resuscitation and antibiotics, the patient was taken for urgent laparotomy. Intraoperatively, we discovered hemoperitoneum and an isolated rupture of the cecum. A right hemicolectomy with end-to-end ileo-transverse colon anastomosis was performed. Her only significant postoperative complication was a superficial wound infection. We review the epidemiology of hollow viscus injury in blunt trauma and discuss important considerations in diagnosis and treatment. Keywords: Blunt abdominal trauma, Cecal rupture, HIV positive, Hollow viscus

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Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v19i1.40442 ◽

2022 ◽

Vol 19 (1) ◽

pp. 106-108

Author(s):

Prabir Maharjan ◽

Shiv Vansh Bharti ◽

Digbijay Bikram Khadka ◽

Anup Karki ◽

Arun Gnyawali

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Primary Repair ◽

Exploratory Laparotomy ◽

Hollow Viscus ◽

Case Presentation ◽

Fourth Part ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Duodenal Injuries

Introduction: Isolated duodenal injuries are rare in blunt abdominal trauma. These present a significant challenge for management because of the associated injuries and its difficult anatomical accessibility. Case presentation: A 20years male presented to the Emergency department following a bike accident sustaining injury over face, chest and abdomen, 6hours after the incident. His vitals were unstable so he was resuscitated and admitted in Intensive Care Unit. He had generalized abdominal tenderness without rigidity. Contrast enhanced computed tomography of abdomen and pelvis was suggestive of hollow viscus perforation. He underwent exploratory laparotomy and primary repair for isolated perforation at fourth part of duodenum. He was discharged on his ninth postoperative day. Conclusion: Rare injuries following blunt abdominal trauma should be considered and early intervention is necessary.

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An experience with blunt abdominal trauma: evaluation, management and outcome

Clinics and Practice ◽

10.4081/cp.2014.599 ◽

2014 ◽

Vol 4 (2) ◽

Cited By ~ 24

Author(s):

Nikhil Mehta ◽

Sudarshan Babu ◽

Kumar Venugopal

Keyword(s):

Early Diagnosis ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

World Health ◽

Common Mechanism ◽

World Population ◽

Diagnosis And Management ◽

Time Of Presentation

Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of <em>years of productive life</em> <em>lost</em> for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives.

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Traumatic gastric rupture following blunt abdominal trauma: a case report about an atypical modality of presentation

Emergency Care Journal ◽

10.4081/ecj.2017.6609 ◽

2017 ◽

Vol 13 (1) ◽

Author(s):

Dario Giambelluca ◽

Dario Picone ◽

Natalino Carmelo Pennisi ◽

Bruno Luciani ◽

Giuseppe Lo Re ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Rare Presentation ◽

Operative Morbidity ◽

Mortality And Morbidity ◽

Vehicle Accident ◽

Gastric Rupture ◽

History Of

Gastric rupture following blunt abdominal trauma is a rare presentation with a reported incidence of 0.02-1.7% in current literature. Traumatic gastric rupture is usually associated with other visceral injuries, such as splenic lesions and fractures. Prompt diagnosis and early intervention reduce mortality and morbidity. History of a recent meal has been implicated in traumatic gastric rupture. 2 We report a case of blunt abdominal trauma with an isolated gastric rupture after a motor vehicle accident, managed successfully without any post-operative morbidity and mortality.

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Blunt abdominal trauma with uterine rupture and fetal demise

Trauma ◽

10.1177/1460408616681601 ◽

2016 ◽

Vol 19 (3) ◽

pp. 219-221 ◽

Cited By ~ 1

Author(s):

Christina Lien ◽

Aamna Ali ◽

John Culhane

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Uterine Rupture ◽

Motor Vehicle ◽

Seat Belt ◽

Fetal Loss ◽

Fetal Demise ◽

Vehicle Accidents ◽

Pelvic Injuries ◽

Minor Injuries

Traumatic uterine rupture is rare, occurring in 0.6% of blunt trauma cases, and usually results from very violent accidents in which patients usually also sustain other major injuries. Following severe blunt abdominal trauma, fetal loss can result from maternal hypotension or hypoxemia, placental abruption, maternal death, and uterine rupture. Although less common, fetal loss can also occur in minor injuries. We report a patient who sustained an isolated anterior uterine rupture with fetal demise without any associated abdominal or pelvic injuries. This case report highlights the importance of proper seat belt usage and placement because both can reduce maternal and fetal morbidity and mortality in motor vehicle accidents.

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Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

Scandinavian Journal of Surgery ◽

10.1177/1457496919828244 ◽

2019 ◽

Vol 109 (2) ◽

pp. 89-95 ◽

Cited By ~ 1

Author(s):

J. Kosola ◽

T. Brinck ◽

A. Leppäniemi ◽

L. Handolin

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Organ Injury ◽

General Surgeon ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Emergency Procedures ◽

Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

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Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

HPB Surgery ◽

10.1155/1993/74027 ◽

1993 ◽

Vol 6 (3) ◽

pp. 163-168 ◽

Cited By ~ 7

Author(s):

D. Henne-Bruns ◽

B. Kremer ◽

D. M. Lloyd ◽

U. Meyer-Pannwitt

Keyword(s):

Portal Vein ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Vena Cava ◽

Prosthetic Graft ◽

Emergency Laparotomy ◽

Distal Pancreatic Resection ◽

Major Injury ◽

Mesenteric Root ◽

Head Of The Pancreas

Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries.

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Successful primary repair of complete pancreatic disruption caused by blunt abdominal trauma: A report of two cases

Surgery ◽

10.1016/s0039-6060(98)70209-0 ◽

1998 ◽

Vol 123 (6) ◽

pp. 702-705 ◽

Cited By ~ 7

Author(s):

Takashi Hashimoto ◽

Yoshihiro Otobe ◽

Youichi Matsuo ◽

Tsukasa Nakamura ◽

Tatsuya Suzuki ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Primary Repair

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Challenges in management of blunt abdominal trauma: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20184078 ◽

2018 ◽

Vol 5 (10) ◽

pp. 3298

Author(s):

Rajkumar P. N. ◽

Kushal Kumar T. R. ◽

Deepak G.

Keyword(s):

Prospective Study ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Imaging Modality ◽

Tertiary Care ◽

Organ Injury ◽

Solid Organ ◽

Vehicle Accident

Background: Trauma meets the pandemic criteria, with a daily worldwide mortality as high as 16000. Abdominal trauma remains a leading cause of mortality in all age groups. Blunt abdominal trauma (BAT) mainly results from motor vehicle accident, fall from height and assaults. The commonest organ injured is the spleen, followed by the liver and small bowel. Lately, the management of BAT has changed from operative to non-operative management. This study was done to analyse the incidence, patterns, current management practiced, and challenges encountered in BAT treated operatively.Methods: This Prospective study was conducted in tertiary care centre in Bangalore during August 2015 to December 2017. 475 patients with blunt abdominal injuries who reported to emergency department were selected for the study based on following inclusion and exclusion criteria.Results: A total of 475 cases of BAT were assessed with a mean age of males and females was 32.6 and 28.3year respectively. Most patients (65%) were between 21 to 30 years of life. Most common mode of injury was motor vehicle accident (57.68%), 60% patients presented to hospital within the initial 4 hours. Abdominal CT had highest accuracy. Most common solid organ injury being spleen (26.5%). 80.84% patients were selected for SNOM and 15.62% had Failed SNOM. 28.48% patients had complications with most common complication wound infection followed by aspiration pneumonia and 7 patients had mortality.Conclusions: Initial resuscitation with thorough clinical examination with correct usage of imaging modalities with timely and proper decision making is the key of management of patients with BAT and there is a need to identify newer imaging modality/procedure which helps to determine better management scheme in all blunt trauma patients.

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Primary Repair of Traumatic Complete Pancreatic Rupture

The American Surgeon ◽

10.1177/00031348211038566 ◽

2021 ◽

pp. 000313482110385

Author(s):

Maria Venianaki ◽

Despoina Ierodiakonou ◽

Evangelia Chryssou ◽

Emmanuel Chrysos ◽

Georgios Chalkiadakis ◽

...

Keyword(s):

Pancreatic Duct ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Primary Repair ◽

Pancreatic Injury ◽

Tissue Loss ◽

Omental Patch ◽

Pancreatic Injuries ◽

Isolated Pancreatic Injury ◽

High Level

Isolated pancreatic injury with transection of the pancreatic duct is generally treated with pancreatic resection, but the optimal management is not based on high-level evidence. Herein, we report a case of primary repair of complete rupture of the pancreas and pancreatic duct after a blunt abdominal trauma and a review of the literature. A 33-year-old patient had an isolated pancreatic injury after blunt abdominal trauma. At laparotomy, an even transection was found with minimal necrosis and tissue loss and an end-to-end anastomosis of the duct and the parenchyma with omental patch was performed. Patient’s postoperative course was complicated by a 6 cm pseudocyst and a low output pancreatic fistula which did not require any intervention and were self-limited. In the literature, 17 cases with primary repair of similar grade IV pancreatic injuries have been reported. Postoperative complications included mostly fistulas and pseudocysts.

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