Complete duodenal disruption from blunt abdominal trauma successfully managed with multistage surgical and endoscopic...

Complete duodenal disruption from blunt abdominal trauma is rare but life-threatening, especially when involving the second and third portions near the ampulla of Vater, which are essential for bile and pancreatic drainage. Such injuries predispose to high-output fistulas, nutritional depletion, and fatal complications. We report a 51-year-old male with multiple abdominal injuries after a high-speed collision, including superior mesenteric vein rupture and complete duodenal disruption. Initial management involved vascular repair and temporary duodenal closure, followed by staged reconstruction with gastrojejunostomy, pyloroplasty, and feeding jejunostomy. Despite these measures, duodenal stump leakage with a high-output biliary fistula developed. Given the hostile operative field, a third-stage multidisciplinary approach was undertaken: endoscopic ultrasound-guided choledochoduodenostomy with endoscopic nasobiliary drainage placement plus surgical drainage. The patient demonstrated clinical improvement, underscoring the value of multidisciplinary collaboration and therapeutic endoscopy in complex duodenal trauma.