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Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
A case of pediatric duodenal transection caused by abuse successfully treated by duodenojejunostomy
Hirotaka Kato1, Yasuyuki Mitani1, Taro Goda1
1Second Department of Surgery Wakayama Medical University Wakayama Japan.
Insights
Pediatric duodenal perforation due to physical abuse requires emergent surgery. A duodenojejunostomy successfully repaired severe duodenal transection in a young boy, highlighting the critical need for prompt surgical intervention in abusive trauma cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Child Abuse Pediatrics
Background:
- Child abuse is a significant cause of pediatric duodenal injury.
- Delayed medical examination in abused children often leads to a poorer prognosis.
- Duodenal injuries in children can result from non-accidental trauma.
Observation:
- A 3-year-old boy presented with abdominal pain and diagnosed duodenal perforation.
- Initial history lacked clear trauma details, but old bruises and contradictory paternal accounts suggested abuse.
- Maternal disclosure confirmed daily paternal domestic violence against the patient.
Findings:
- Intraoperative findings revealed a severe transection at the horizontal part of the duodenum.
- Primary repair was not feasible due to the extent of duodenal damage.
- A duodenojejunostomy was performed as an emergent surgical procedure.
Implications:
- Duodenojejunostomy is a viable emergent surgical solution for severe duodenal transection in pediatric abuse cases.
- Prompt surgical intervention is crucial for improving outcomes in children with abusive trauma.
- This case underscores the importance of considering non-accidental trauma in pediatric abdominal emergencies.
Background:
Abuse can be a cause of pediatric duodenal injury. Patients who have been injured by abuse tend to have delay before medical examination, they may therefore have especially poor prognosis.
Case Presentation:
A 3-year-old boy presented with abdominal pain and was diagnosed with duodenal perforation. He was urgently transferred to our hospital for surgery. There was no clear history of trauma according to initial parent interviews, but old bruises were observed in several places. Paternal remarks about the injury mechanism were contradictory to bruit findings. Eventually, the mother reported daily paternal domestic violence against the patient. Duodenal perforation was considered to be caused by physical abuse, and emergent surgery was carried out. Intraoperative findings revealed transection at the horizontal part of the duodenum. Primary repair was difficult due to severe damage, so duodenojejunostomy was undertaken.
Conclusion:
Duodenojejunostomy was successfully carried out as emergent surgery for severely damaged duodenal transection.
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