Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma

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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Specific Radiological Findings of Traumatic Gastrointestinal Tract Injuries in Patients with Blunt Chest and Abdominal Trauma

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.11.003 ◽

2015 ◽

Vol 66 (2) ◽

pp. 158-163 ◽

Cited By ~ 6

Author(s):

Nima Kokabi ◽

Elie Harmouche ◽

Minzhi Xing ◽

Waqas Shuaib ◽

Pardeep K. Mittal ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Trauma ◽

Early Recognition ◽

Radiological Findings ◽

Hollow Viscus ◽

Contrast Enhanced ◽

Hollow Viscus Injury ◽

Pictorial Essay ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma.

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Role of Computed Tomography in Blunt Abdominal Trauma

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v19i1.40232 ◽

2022 ◽

Vol 19 (1) ◽

pp. 55-58

Author(s):

Digbijay Bikram Khadka ◽

Anup Sharma ◽

Ashish Bhatta ◽

Prabir Maharjan ◽

Sandesh Sharma

Keyword(s):

Computed Tomography ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Computed Tomography Scan ◽

Female Ratio ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Time Of Presentation ◽

Contrast Enhanced Computed Tomography ◽

Tomography Scan

Introduction: Blunt abdominal trauma is one of the commonly encountered surgical emergencies. The diagnostic modality that helps in optimum management of these patients includes chest and abdominal x-rays, Focused Assessment Sonography for Trauma scan and Computed Tomography. In selected hemodynamically stable patients who are candidates for non-operative management, Contrast Enhanced Computed Tomography is not considered essential and hence avoiding its own radiation hazards and decreasing extra financial burden to the patients. Aims: To evaluate whether Contrast Enhanced Computed Tomography is necessary or not in case of blunt trauma abdomen. Methods: This is a hospital based prospective study done in the department of surgery at Nepalgunj Medical College, Kohalpur conducted from October 2020 to March 2021. The patients with blunt abdominal trauma who were hemodynamically stable at the time of presentation and those who became stable after resuscitation were included. These patient’s detailed history was taken, clinical examination done. Focused Assessment Sonography for Trauma scan was done at the time of presentation along with chest x-ray and other necessary blood investigation. Data were analyzed with Statistical Package for Social Sciences version 25 and p-value <0.05 was taken as significant. Results: Out of total 53 patients, age group between 11-20 and 21-30 years comprising of 13 patients with male: female ratio of 1.94:1 were affected more. Fall injury, being the most common mode, comprised 20 patients. The commonest organ involved was spleen seen in 17 patients (32.1%), liver in 16 patients (30.2%). In 44 (83.0%) patients, Computed Tomography scan was done only in nine patients who were also managed conservatively, except one who underwent laparoscopic evacuation of collected blood. Seventeen (32.1%) patients underwent repeat ultrasonography without any new findings. Conclusion: Patients with blunt abdominal trauma with stable hemodynamics can be managed conservatively with limited use of Contrast Enhanced Computed Tomography scan.

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

BMC Surgery ◽

10.1186/s12893-020-00882-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chun-Chi Lai ◽

Hung-Chang Huang ◽

Ray-Jade Chen

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Motor Vehicle ◽

Primary Repair ◽

Motor Vehicle Crash ◽

Tube Placement ◽

Emergency Laparotomy ◽

Severe Peritonitis ◽

Enhanced Computed Tomography ◽

Perforating Injury

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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Outcome of gastrointestinal perforations due to blunt abdominal trauma

International Surgery Journal ◽

10.18203/2349-2902.isj20183200 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2836

Author(s):

Anubhav Goel ◽

Ankur Bansal ◽

Bhupesh Gogia

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Postoperative Period ◽

Blunt Abdominal Trauma ◽

Exploratory Laparotomy ◽

Gastrointestinal Perforation ◽

Common Site ◽

Hollow Viscus ◽

Abdominal Sonography ◽

Isolated Injury

Background: The most common injury during blunt abdominal trauma (BAT) is of solid organs. Hollow viscus injuries are much more uncommon compared to the non-hollow ones. The most important problem associated with these conditions that they are frequently remain undetected or diagnosed too late despite advanced techniques such as focussed abdominal sonography for trauma (FAST), computer tomography, and magnetic resonance imaging. This study evaluates gastrointestinal perforation following blunt abdominal trauma, their anatomical distribution, diagnosis, management, and outcome.Methods: The study was a prospective observational study conducted after ethical clearance from hospital. The patients included were those presenting with features of peritonitis following blunt trauma, with isolated injury to abdomen and found to exhibit gastrointestinal perforation on exploratory laparotomy. Exclusion criteria were perforation was not detected at surgery, penetrating abdominal trauma. Data of each patient were collected into the Performa prepared for the study.Results: During the study period, 32 patients underwent surgery for perforation following blunt abdominal trauma. Jejunum was the most common site of perforation in the study subjects followed by ileum than stomach. Among the procedures performed, simple closure of perforation with peritoneal lavage was the most commonly performed procedure in 24 patients (75.0%). Resection anastomosis was done in 3 (9.3%) cases, while stoma was fashioned in 5 (15.6%) patients. 5 (15.6%) patients developed complications in the postoperative period with chest infection being the most common. One patient died in the postoperative period leading to mortality rate of 3.1%.Conclusions: To conclude, early diagnosis and treatment are of utmost importance. Most common site for perforation in blunt trauma is jejunum. Early surgery following adequate resuscitation in gastrointestinal perforation following blunt trauma abdomen is associated with a very a good outcome.

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Hollow viscus injury due to blunt abdominal trauma

International Surgery Journal ◽

10.18203/2349-2902.isj20170429 ◽

2017 ◽

Vol 4 (3) ◽

pp. 861 ◽

Cited By ~ 1

Author(s):

Surya Ramachandra Varma Gunturi ◽

Venu Madhav Thumma ◽

Jagan Mohan Reddy Bathalapalli ◽

Nava Kishore Kunduru ◽

Kamal Kishore Bishnoi ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Close Monitoring ◽

Medical Sciences ◽

Hollow Viscus ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Hollow Viscus Injury ◽

Time Of Presentation

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

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BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.842 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Dhawal Panchal ◽

Firdaus Dekhaiya ◽

Harin Tailor

Keyword(s):

Hospital Stay ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Exploratory Laparotomy ◽

Blunt Injury ◽

Abdominal Drainage ◽

Duration Of Hospital Stay ◽

Considerable Morbidity ◽

Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords: Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

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Intraperitoneal Urinary Bladder Rupture as a Cause of Pneumoperitoneum

The American Surgeon ◽

10.1177/00031348211025765 ◽

2021 ◽

pp. 000313482110257

Author(s):

Dar Parvez M ◽

Kour Supreet ◽

Sharma Ajay ◽

Kumar Subodh

Keyword(s):

Urinary Bladder ◽

Primary Repair ◽

Exploratory Laparotomy ◽

Pelvic Trauma ◽

Bladder Rupture ◽

Abdominal Pressure ◽

Trauma Patients ◽

Hollow Viscus ◽

Sudden Rise ◽

Intraperitoneal Bladder Rupture

The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.

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