CLINICAL CASE OF POST-TRAUMATIC THROMBOSIS AND PERFORATION OF THE DISTAL PART OF THE DUODENUM FOLLOWING A STEERING WHEEL IMPACT IN BLUNT ABDOMINAL TRAUMA

The article presents a clinical case of traumatic injury of the distal duodenum as a result of blunt abdominal trauma in the form of complete rupture and segmental post-traumatic thrombosis of the proximal part of the small intestine with the analysis of literature data for the diagnosis and choice of surgical correction tactics. Injuries of such localization are relatively rare and account for 0.9-5% of abdominal organ injuries, but complicated diagnostics, lack of standardized surgical tactics and high lethality - from 10 to 40% determine the relevance of the problem for research and sharing of own experience. Rupture of the duodenum after blunt wheel-associated trauma of the abdomen is a statistically rare injury. In most cases, this is caused by a high-kinetic impact. It is rarely isolated, and is usually associated with other visceral lesions. Early diagnosis is important to reduce complications and mortality, as most severe duo-denal injuries require surgical treatment, the choice of which depends on the severity of the injury. The anatom-ically deep location of the duodenum provides a strong enough protection for anterior and posterior injuries due to the spine and massive muscle layer. As a result, me-chanical damage is quite rare, but from a clinical point of view, such natural protection has negative consequences due to complex, sometimes late, diagnosis, which leads to the development of severe complications and high mor-tality. Thus, the period from injury to treatment is a de-termining factor that determines the likelihood of compli-cations and, of course, the outcome of treatment. However, the complexity of the diagnosis leads to a delay in determining the damage to the duodenum > 12 hours іn 53%, and in 28% the diagnostic time exceeds> 24 hours. It is known that the delay in timely diagnosis of duodenal injury for more than a day, leads to an increase in mortality to 40%, while the diagnostic at a later date causes mortality, which is close to 100% [8]. Isolated damage to the duodenum is rare. If dur-ing the urgent diagnosis of a closed abdominal injury it is possible to detect damage to the duodenum in a timely manner, then in most cases the primary reconstructive operations are successful. In cases of late diagnosis, not only is there a need for complex surgical procedures, but also it increases the risk of serious complications, which leads to high mortality. This clinical case once again shows that the choice of surgery for duodenal injuries should be differ-entiated and determined by the general and intra-abdominal situation (concomitant damage to the pancre-as, the probable spread of thrombosis, the degree of traumatic shock, etc.). The method of choice of surgical intervention is mobilization of the retroperitoneal de-partment of the intestine with the imposition of duode-noic anastomosis and disconnection of the gastro-duodenal passage accordingly.