A case of traumatic isolated duodenal perforation due to blunt abdominal trauma

Isolated duodenal injury following blunt abdominal trauma is a rare clinical entity and is often unnoticed leading to delay in management thereby increasing morbidity and mortality. We report a case of isolated duodenal perforation following blunt abdominal trauma and highlight the challenges and decision-making dilemmas associated with its management. The present patient had two perforations, one on the anterior and the other on the posterior wall of the duodenum. Complete duodenal mobilization during laparotomy and a decision of performing pyloric exclusion aided momentously in the management.

Impacto de la infección por SARS-CoV-2 (COVID-19) en el tratamiento de una lesión duodenal por arma de fuego

We report the case of a patient with an abdominal gunshot trauma with liver and duodenal injury who underwent pyloric exclusion and liver repair in another institution. The patient was transferred to our institution 12 hours after surgery. During hospitalization, severe pneumonia due to COVID-19 and complications of the initial surgery developed. Non-surgical management was decided due to the severity of the disease. Percutaneous drainage allowed for the management of the collections avoiding a major initial surgery. Once he recovered from the pneumonia, the definite surgery was performed. Severe COVID-19 pneumonia in a patient with serious duodenal shotgun injury is a determining factor for decision-making of treatment options.

Endoscopic ultrasound–guided luminal remodeling as a novel technique to restore gastroduodenal continuity

Pyloric exclusion is a method of treatment for duodenal injury. Surgery is usually needed to restore digestive continuity in due time, yet a new surgical procedure can be challenging due to fibrotic adhesion development. We present here a retrospective case series of three patients with pyloric exclusion who underwent endoscopic ultrasound–guided duodenal repermeabilization using metallic stents. All procedures were successful with no complication and allowed regular feeding. This case series shows that endoscopic ultrasound–guided recanalization is a feasible and safe procedure.

Duodenal Trauma

Duodenal trauma is rare enough to prevent most surgeons from having extensive experience with its management, but not so unusual as to be ignored. The challenges are not simply in the operative decision-making, but also in the timely diagnosis. The duodenum accounts for only 5% of intra-abdominal traumatic injuries, likely owing to its deep, mostly retroperitoneal location. Fully three-quarters of duodenal injuries reported in the world’s literature are from penetrating wounds, and nearly all (90%) will have associated intra-abdominal injuries. Hemorrhage control, halting contamination, and definitive repair of the duodenal injury are the hallmarks of good management. The grade or severity of the duodenal injury will direct the appropriate surgical repair technique. Timely diagnosis is imperative, for a delay will increase mortality four-fold. This review contains 6 figures, 2 tables, and 24 references. Key Words : Duodenum; Pylorus; Injury; Trauma; Pyloric exclusion; Amylase; Lipase; tube-duodenostomy; Whipple procedure; Retroperitoneum

Role of Pyloric Exclusion in Duodenal Trauma - Historical Perspective

Background: Majority of duodenal injuries requires simple repair. Pyloric exclusion is recommended for injuries involving 50-70% of circumference. This adjunct procedure has specific complications. The benefit is uncertain. This review article assesses the benefit of the procedure Methods: Published literature over the last two decades was reviewed. It was sourced from indexed journals and Medline. Conclusion: The role remains equivocal. Perhaps some advantage in delayed or failed duodenal repair. The incidence of complications may be substantial.