Self-inflicted Abdominal Stab Wound Causing Penetrating Injury of the Duodenum and Pancreatic Head: A Case Report

Abstract

A 42-year-old woman, who was under outpatient treatment for schizophrenia at another hospital, was transported to our hospital by ambulance 105 minutes after she stabbed herself in the abdomen with a knife. Contrast-enhanced computed tomography (CT) suggested damage to the pancreatic head and to the region of the gastrointestinal tract from the gastric antrum to the duodenum. Emergency laparotomy was performed 255 minutes after the injury, which revealed that the tip of the knife had penetrated the duodenal bulb and parenchyma of the upper border of the pancreatic head (width：approximately 5 mm) and reached the ventral aspect of the vertebral body； therefore, gastroduodenectomy including the perforated site of the gastrointestinal tract was performed, with closure of the pancreatic head by suturing. In Japan, patients with abdominal stab wounds are only infrequently encountered by surgeons. In our patient reported herein, the knife was still in place at presentation, making detailed preoperative assessment difficult. However, treatment by meticulous surgery resulted in a favorable course of the patient.