2014 Volume 34 Issue 5 Pages 1033-1038
We report herein on a case of blunt duodenal injury that was missed during the primary surgery. A 79-year-old female was transferred to our hospital following a road traffic accident. Computed tomography (CT) revealed fractures of the ninth and tenth ribs. However, due to a temporary reduction of systolic blood pressure, an enhanced CT was performed that revealed intra-abdominal hemorrhage due to injury of the spleen and adjacent tissue at the greater curvature. Emergency surgery revealed a gradeⅠ splenic injury and an omental and mesenteric hematoma with 1,000 mL of bloody ascites. Therefore, we performed a splenectomy, but on postoperative day 2 the patient developed severe abdominal pain, high fever, and septic shock. We suspected some missed injury, and performed a second emergency surgery, which revealed a gradeⅡ duodenal laceration requiring simple closure and duodenal diverticulation. Despite some postoperative complications, including acute respiratory distress syndrome and leakage at the repair site, the patient was successfully discharged after 89 days of admission. It is important to consider that duodenal injury can easily be overlooked during emergency surgery; performing appropriate surgical procedures can help to avoid postoperative complications.