Partial Resection of the Second Portion of the Duodenum for Traumatic Duodenal Injury Caused by a Wire in a Child

Abstract

Among the anatomical and physiological factors of traumatic duodenal injury, dehiscence is known to occur at a high incidence rate when only simple suture closure is performed. Various types of schemes are required for the surgical modality. We report the findings in a case of partial resection of the second portion of the duodenum for traumatic duodenal injury caused by a wire. The patient was a 14-year-old boy rushed to our hospital after he struck his upper abdomen on a net wire during tennis practice. At admission he had intense pressure pain accompanied by peritoneal irritation symptoms in the left upper abdomen. From the contrast-enhanced CT findings, traumatic duodenal and pancreatic injuries were suspected. Hence, an emergency surgery was performed. The intraoperative findings showed a slight subcircumferential perforation, 10 cm in diameter, in the second portion of the duodenum. Intraoperative pancreatic duct imaging revealed no injury of the main pancreatic duct. Partial resection of the second portion of the duodenum was performed. For traumatic duodenal injuries, diagnosis and the choice of surgical modality are not easy, and difficulties may be encountered due to postsurgical complications. To rescue such patients, rapid diagnosis and appropriate surgery in the early stage of injury must be performed to prevent over-invasion.