In a 10-year period ending December 1983, 56 patients with duodenal injuries were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. Most injuries consisted of isolated duodenal lacerations or perforations (37), five patients had duodenal hematomas, and 14 patients had injuries involving the duodenum, pancreas, ampulla, and/or common bile duct. Most injuries were successfully managed with suture repair. The Whipple procedure was necessary in five cases. Overall morbidity was 39.2 per cent, but complications directly related to the duodenal injury occurred in only six patients (10.7%). Only three patients died (5.3%). Excellent results can be achieved even with extensive duodenal injuries by the use of careful debridement and primary closure. When injuries to the duodenum are associated with injury to the ampulla of Vater, the head of the pancreas, or the common bile duct, a Whipple procedure is usually necessary. It has not been necessary to employ duodenal bypass or diverticulization.

Recent experiences with duodenal trauma

La perforazione isolata del digiuno ricorre, come complicazione di un trauma chiuso dell’addome, nel 5% dei casi. I tipici segni, quali aria libera nelle immagini radiografiche o peritonismo alla valutazione clinica, impiegano mediamente 12-24 ore a manifestarsi.
Presentiamo 3 casi di perforazione isolata del digiuno dopo trauma chiuso dell’addome, di cui uno soltanto diastasico.
La TC dell’addome e stata risolutiva nell’identificazione della condizione. I due segni tipici sono stati l’aria libera, anche se modesta in tutti e tre i casi, e il marcato ispessimento di alcune anse digiunali con “enhancement” positivo

Isolated jejunal perforation after blunt trauma. Report of three cases.

AIM: To discuss the efficiency of RTS (Revised Trauma Score), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.METHOD and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. FINDINGS: Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intra-abdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference. However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) CONCLUSION: Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk. Language: en

/pdf/gastrointestinal-injuries-in-blunt-abdominal-traumas-2g5qit2odc.pdf

Gastrointestinal Injuries in Blunt Abdominal Traumas.

The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults' abdominal visceral injuries after flipping the bike's handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.

/pdf/isolated-jejunal-perforation-following-bicycle-handlebar-433dhkumhm.pdf

Isolated Jejunal Perforation Following Bicycle Handlebar Injury in Adults: A Case Report

Isolated small intestine injury because of blunt trauma is a rarely encountered situation. Because it is difficult to diagnose, this injury can be associated with a prolonged clinical course and delay in treatment. In this article, we present an isolated full-thickness ileal trauma associated with a motor vehicle traffic accident. A 35-year-old male patient was kept under observation at another medical center following the motor vehicle traffic accident and was discharged early because no pathology was detected. He was later referred to our hospital’s emergency clinic with complaints of abdominal pain and vomiting after approximately 12 hours. The patient with acute abdomen was assessed by physical examination, laboratory tests, and imaging and was taken into surgery under emergency conditions. A full-thickness isolated ileal perforation and approximately 300 mm3 of intestinal contents were detected by laparotomy. Resection of necrotic tissues and end-to-end anastomosis was performed. During the post-operative period, he was discharged without complications. Even in situations in which a thorough investigation and examination are performed, considering that there might be an isolated case of small intestine trauma, it is very important to extend the monitoring, imaging, and observation periods of patients with blunt trauma with repeated physical examinations. (Eurasian J Emerg Med 2015; 14: 204-6)

/pdf/full-thickness-isolated-small-intestine-injury-due-to-blunt-26tw3vr1iq.pdf

Full-Thickness Isolated Small Intestine Injury Due to Blunt Trauma

Blunt abdominal trauma causing jejunal perforation is rare occurrence and is usually expected after a motor vehicle accident. In this study, we present a case of jejunal perforation caused by impact of a knee to the abdominal area. A 21-year-old man was admitted to the emergency department after blunt trauma caused by a knee kick. He described a sudden pain at the whole abdomen after trauma. On his physical examination, there was tenderness on the left abdomen at palpation. All blood tests, pulse rate, temperature, and blood pressure were within normal range. Free air was detected under the diaphragm on upright plain x-ray. Computed tomography revealed free air and fluid in the abdomen. In the laparotomy, approximately 200 cc of intestinal fluid was found leaking from a jejunum perforation on the antimesenteric aspect, 60 cm from the Treitz ligament. Resection was performed and ends of the intestines sutured primarily. The patient was discharged from the hospital on the 10th postoperative day without any complication. The diagnosis of jejunal perforation after blunt trauma is a dilemma. The mechanism of injury, history, and serial physical examination play an important role in diagnosis. Therefore, there is a suspicious aspect to this kind of case. For optimal management, repeated physical examination and available radiologic techniques are important cornerstones.

Turgut Tufan

Papers

Perforation of isolated jejunum after a blunt trauma: case report and review of the literature.