Unusual clinical course, Challenging differential diagnosis, Rare disease
Jan-Peter Correia Sousa Périssé, Ana Luiza de Carvalho Miranda Rosati Rocha, Raphael Lessa Coelho, Bruno Guerra Campanario, Luis Fernando Rosati Rocha
Medical School, Fluminense Federal University, Niterói, RJ, Brazil
Am J Case Rep 2020; 21:e927461
Available online: 2020-10-26
Duodenal trauma usually consists of retroperitoneal lesions. Its management can be complicated by the location of the injury and difficulty in making an early diagnosis. Duodenal injuries are divided into blunt and penetrating trauma, and the possible results are hematoma, laceration, and devascularization. Duodenal lesions due to blunt trauma are usually accompanied by lesions of nearby organs. We present a rare case of a single duodenal laceration due to blunt abdominal trauma caused by a horse kick, along with a literature review.
CASE REPORT: A 13-year-old boy presented to our emergency department after being kicked by a horse in his abdomen. He was stable and complained of abdominal pain without any other specifications. Computed tomography imaging revealed a retropneumoperitoneum and free fluid in the abdominal cavity. The patient was taken for an emergency laparotomy, which showed a single duodenal laceration of the second and third portions of the duodenum. The laceration was repaired with a double-layer closure using monofilament 3-0 polypropylene suture. The patient recovered from his injuries and was well at his last follow-up.
CONCLUSIONS: This case highlights the possible outcomes of an innocent blunt trauma and the importance of early diagnosis for the best outcome of a duodenal laceration. It also identifies the dissociation between the patient’s clinical presentation and his significant intra-abdominal injury.
Keywords: Abdominal Injuries, Lacerations, Retropneumoperitoneum, Wounds and Injuries, Wounds, Nonpenetrating