Laparoscopic Surgery for Duodenal Perforation without Intramural Contusion Immediately After Epigastric Trauma

Abstract

A 51-year-old male presented with intense epigastric pain immediately after a bogie had struck his epigastrium 2 hours post lunch. On examination, his vital signs were stable, but he reported intense abdominal pain accompanied by symptoms of peritoneal irritation. Routine hematological studies revealed elevated white blood cell counts. Enhanced computed tomography revealed free air around the liver. On the basis of these findings, we diagnosed the patient as having traumatic digestive tract perforation. Laparoscopic examination performed 8 hours following the injury revealed contaminated ascites throughout the peritoneal cavity and a round perforation of the duodenal bulb without intramural contusion around the hole, similar to a perforated peptic duodenal ulcer. Accordingly, we performed laparoscopic simple closure, omental covering and drainage, the same procedure as is usually done for a perforated peptic duodenal ulcer. Notably, his postoperative course was unremarkable, and the patient was discharged on the 9th postoperative day. Herein, we report on a rare case of a duodenal perforation without contusion immediately after epigastric trauma, which was easily detected and treated using laparoscopic surgery, in a similar manner to the treatment of perforated peptic duodenal ulcers.