Isolated retroperitoneal duodenal perforation after blunt abdominal trauma, an often-missed injury: A case report

Duodenal injuries occur in significant number of patients after abdominal trauma. Though most, 75 %, occur after penetrating mechanism of injury the remaining occur after blunt trauma and these are the commonly missed cases unless high index of suspicion is maintained. Here we presented a case of isolated retroperitoneal duodenal perforation after blunt abdominal trauma with a delayed diagnosis and management.

A 38-year-old male patient presented to our trauma center with a blunt hit to the abdomen, which was described to be tribal, by the patient. He underwent exploration after 7 days of the trauma due to a persistent right upper quadrant pain and tenderness, and duodenal repair, abscess drainage, pyloric exclusion with gastrojejunostomy was done for duodenal perforation. Post operatively he was discharged improved after several days of stay in the hospital.

The duodenum is rarely injured in isolation due to its retroperitoneal location and closeness to multiple organs and structures, including the liver, right kidney, common bile duct, and colon. Consequently, an isolated duodenal laceration is a noteworthy outlier, particularly in cases where blunt mechanism is incriminated. Duodenal injury after blunt abdominal traumas may be underestimated in severity or altogether overlooked because there are no significant signs of the injury on the outside. There is a wide array of management options based on the clinical scenario.

Maintaining high index of suspicion and early diagnosis are critical to decrease morbidity and mortality and for better outcome in patients with duodenal injury.