Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

• Published in: Il Giornale di chirurgia 2013-04, Vol.34 (4), p.122-124
• Main Authors: Torba, M, Gjata, A, Buci, S, Troci, A, Subashi, K
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Child, Preschool; Clinical Practice; Delayed Diagnosis; Digestive System Surgical Procedures; Duodenum - diagnostic imaging; Duodenum - injuries; Duodenum - surgery; Humans; Intestinal Perforation - diagnostic imaging; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Male; Radiography; Treatment Outcome; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - etiology; Wounds, Nonpenetrating - surgery
• ISSN: 0391-9005; 1971-145X

Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm³. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.