[Rupture of the duodenum due to blunt injury]

Injuries of the duodenum, although rare, have increased in frequency of occurence during the past ten years. Careful attention must be given to them, especially if the injury was brought about by a blunt blow of the abdominal, and lower thoracic regions. X-rays are the most important means used in diagnosing such cases. Injuries of the duodenum often occur along with injuries of other related structures, especially in polytraumatized patients. Early diagnosis, and surgical treatment are conditio sine qua non for successful results. During the operation itself, a compete inspection of the entire duodenum, both intra and extraperitoneal parts, careful placement of sutures about the perforation and an exact drainage are of utmost importance in the prevention of postoperative complications. In cases in which the duodenal wall has lost its vitality for accepting suture, a gastrojejunal, duodenojejunal anastomisi, or gastrostomia are performed, the content of the duodenum is aspirated, the duodenum is decompressed and adequate drainage of the peritoneal cavity is established. In cases of accompanying injury of the pancreas, or choledochus, a drainage of the extrahepatic bile duct is recommended. The authors discuss one case with a ruptured duodenum, resulting from blunt trauma, in which all of the above mentioned procedures were used; they insist that any suspicion of a duodenum's rupture indicates an immediate laparotomy.