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Double isolated asynchronous duodenal perforation due to abdominal blunt trauma in a child: A case report
V Briganti1, S Tursini1, S Ianniello2
1Pediatric Surgery Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy.
Insights
This case report details an 11-year-old boy with an asynchronous double isolated duodenal perforation (IDP) after blunt abdominal trauma. Prompt diagnosis and surgical repair were crucial for recovery from this rare pediatric injury.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Gastrointestinal surgery
Background:
- Isolated duodenal perforation (IDP) is a rare pediatric injury from blunt abdominal trauma.
- Bicycle accidents are a common cause of blunt abdominal trauma in children, sometimes leading to IDP.
- Timely diagnosis and surgical intervention are critical to reduce morbidity and mortality in pediatric IDP cases.
Observation:
- An 11-year-old boy presented with blunt abdominal trauma and was diagnosed with an asynchronous double IDP.
- The first duodenal perforation was identified via CT scan and repaired with a single stitch suture.
- A second perforation in the duodenal bulb appeared 48 hours later, diagnosed by endoscopy and also surgically repaired.
Findings:
- The patient required a third laparotomy due to intestinal obstruction following the two perforation repairs.
- Complete recovery was achieved after the third surgery, with the patient discharged home.
- This represents the first reported case of a double isolated asynchronous duodenal perforation in a child following blunt abdominal trauma.
Implications:
- This case highlights the potential for multiple, asynchronous duodenal perforations after blunt abdominal trauma in children.
- It underscores the importance of vigilant monitoring and advanced imaging for diagnosing rare pediatric trauma complications.
- The successful management emphasizes the adaptability of surgical techniques for complex duodenal injuries in pediatric patients.
Background:
Isolated duodenal perforation following blunt abdominal trauma is a rare injury in children. Bicycle accidents (falling on to the handlebar) are a frequent cause of blunt abdominal trauma in children and may occasionally be associated with isolated duodenal perforation (IDP). Prompt diagnosis and surgical treatment are vital to prevent increased morbidity and mortality.
Case Presentation:
We report the rare case of an 11-year-old boy admitted for blunt abdominal trauma and treated for an asynchronous double IDP. The first perforation, located on the 2nd/3rd portion of the duodenum, was promptly diagnosed by contrast-enhanced abdominal CT scan after a negative US scan, five hours after injury, and the lesion repaired with a single stitch suture. The second duodenal perforation appeared in the duodenal bulb as a worsening biliary leakage, 48 h after the primary suture of the initial lesion. The perforation was initially seen by digestive endoscopy and sutured in the same way as the first lesion. A third laparotomy was needed 4 days later due to an intestinal obstruction, after which the patient was recovered completely and was discharged home.
Discussion And Conclusion:
IDP is a rare consequence of blunt abdominal trauma, and is normally associated with a lesion of other organs, such as the pancreas or bile duct. A delayed diagnosis strongly increases the incidence of morbidity and mortality, and different kinds of surgical management have been proposed, depending on the type of lesion. To our knowledge, this is the first case described in literature of a double isolated asynchronous duodenal perforation following blunt abdominal trauma in children.
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