POST TRAUMATIC RETROPERITONEAL DUODENAL PERFORATION

Duodenal injury is less common after blunt injury abdomen. Blunt injury constitutes 22 percentage of all duodenal injuries. It constitutes 3-5 percent of all abdominal injuries. Most common in the second and third portions. Usually accompanied by other intra abdominal injuries. There are various treatment for duodenal injuries according to grading. Treatment consists of simple suturing to whipples procedure. Here we report a case of duodenal injury who presented with abdominal pain, vomiting, fever and abdominal distension after blunt injury abdomen for 2 days. On examination patient is dehydrated, febrile, vitals stable. Abdomen distended, generalised tenderness, guarding, rigidity present. Free fluid present. Blood investigations normal except Hb-10.8 gram per deciliter. Serum amylase and lipase normal. Four quadrant aspiration positive. Plain x ray abdomen and contrast enhanced CT scan confirmed the diagnosis and showed retroperitoneal pneumoperitoneum. Laparotomy done, patient had perforation in D2, D3 junction in the posterior wall. Patient was treated successfully by suturing the perforation in two layers, duodenal diverticulization with Billroth II anastomosis, jejunojejunostomy and feeding jejunostomy. Post operative events uneventful. Patient is under regular follow up. To conclude, any bile staining in the peripancreatic area should be explored, both the Kocher manoeuvre and the CattellBraasch exposure is essential. Duodenal injury usually has late presentation, so early diagnosis and treatment can prevent morbidity and mortality.