Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review
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CASE REPORT
Open Access
Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review Chun-Chi Lai1* , Hung-Chang Huang1 and Ray-Jade Chen2
Abstract Background: Gastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify. Case presentation: A young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass. Conclusions: Assessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival. Keywords: Blunt abdominal trauma, Stomach perforation, Duodenum perforation, Handle-bar injury, Retroperitoneal hematoma
Background Traumatic gastrointestinal injury is an injury to the stomach, duodenum, small bowel, or colon following blunt or penetrating abdominal trauma. In patients who have sustained blunt abdominal trauma, the incidence rates of gastrointestinal, stomach, and duodenal injuries are 0.81–3.1%, 0.1, and 0.4%, respectively, according to previous studies [1–3]. Moreover, a * Correspondence: [email protected] 1 Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan Full list of author information is available at the end of the article
perforating injury of both the stomach and duodenum following abdominal trauma has rarely been reported. High morbidity and mortality rates have been reported for patients with traumatic gastrointestinal injury and have been associated with misdiagnosis, severe intra-abdominal infection, and sepsis. In combined-organ injuries, we could easily be distracted by one injury and overlook the other. Therefore, accurate diagnosis and timely surgical intervention are crucial. We report a rare case of a combined stomach and duodenal perforating injury.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropria
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