RETROPERITONEAL DUODENAL INJURY FOLLOWING BLUNT TRAUMA ABDOMEN- A CASE REPORT AND REVIEW OF LITERATURE

Dr. Albail Singh Yadav, Dr. Sridham Sutradhar, Dr. Avinash Kumar Srivastava, Dr. Ridima Behl

Abstract


A 12yr old boy had blunt trauma abdomen due to a fall of a portion of wall on his abdomen while he was sleeping.
He went to a private hospital where he was admitted for about 12hrs and was then referred to our institute. At
presentation here he had pulse rate-120/min, blood pressure- 90/60mmHg, abdomen distended with generalized guarding present. He
was resuscitated and investigated. X-ray abdomen showed free gas under diaphragm. A diagnosis of perforation peritonitis was made. He
then underwent exploratory laparotomy. On exploration, thinned out bluish black bulge in retroperitoneum in infracolic region on right
side was seen. The thinned necrotic peritoneum over bulge was opened. There was discharge of bilious and fecal material from the opening.
Suctioning and lavage was done and a complete transaction¹ of duodenum at D2 – D3 junction was found. Both the proximal and distal
ends of duodenum were mobilized, margins freshened and a primary end to end anastomosis² was accomplished in a tension free manner
with 2-0 Monocryl in a single layer. Antecolic isoperistaltic gastrojejunostomy³ was also done as an adjunct procedure to prevent leak and
drains were inserted in the paraduodenal area and pelvis.In the post operative period patient had bilious discharge from paraduodenal
drain for about 2 weeks. Initially it was around 200ml, with time it decreased to about 50ml by the end of 1 week. After 2 weeks drainage st
stopped. Patient was allowed orally after 5days of surgery, initially liquids then shifted to semisolid diet. After 2 weeks drain removed and
patient discharged on postoperative day 20 in stable condition.


Keywords


Retroperitoneal Duodenal Injury, Gastro Jejunostomy, Traumatic D2-d3 Transaction, Triple-tube-ostomy, Pylorus Exclusion

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References


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