EN
TÜRKÇE
Poster - 123
Isolated duodenal perforation in children: Importance of high index of suspicion following blunt trauma abdomen and its management in resource limited countries.
Sajad Wani
SUBHARTY UNIVERSITY UTTER PRADESH INDIA
Introduction:Isolated duodenal perforation (IDP) is rare and only isolated cases are reported in the literature. Due to its rarity and subtle presentation, the diagnosis of IDP is often delayed. Delay in the diagnosis and surgical intervention result in increased morbidity and mortality particularly in underdeveloped countries. The aim of this article is to highlight the importance of a high index of suspicion of IDP following blunt abdominal trauma and its management in resource limited/underdeveloped countries.
Material and methods: Children with isolated duodenal injuries following blunt abdominal trauma were included; mode of trauma, clinical presentation, diagnosis, operative intervention and outcome were studied. Primary repair of perforation was performed in all cases. Continuous feeding was started next day through long nasojujenal tube which was inserted during the surgery. None of the patient had feeding jujenostomy or use of parental nutrition.
Results:Nine patients with isolated duodenal perforations were identified and operated. Most of them had minimal clinical findings on arrival and were haemodynamically stable. Abdominal radiography and ultrasonography were unremarkable. However, pain remained persistent and worsening of vomiting was seen over time. Contrast-enhanced computed tomography of the abdomen with oral and intravenous contrast was done to identify the injuries. There were three Grade 2 duodenal perforation injuries, five Grade 3 and one Grade 4 injuries. Eight patients healed well with uneventful recovery. One patient died from sepsis after presenting 24 h after injury with frank peritonitis.
Conclusion:Isolated duodenal perforation presents without specific signs and symptoms and a high index of suspicion is necessary for early diagnosis. Contrast-enhanced computed tomography of the abdomen with oral contrast should be ordered early if symptoms persist or worsened over time. Primary repair of perforation and use of continuous feeding next day through long nasojujenal tube is safe and effective particularly in resource limited/underdeveloped countries.