The patient was hospitalized for observation. On the following day, he presented worsening upper abdominal condition, with a body temperature of 39��C. Consequently, 28 hours after MVC the patient was transferred to our National Trauma Center for further diagnostics and treatment. At admission the boy complained about worsening epigastric condition. selleck chem His vital signs were; pulse rate; 135/min, Blood Pressure; 70�C110 mm Hg, respiratory rate; 35/min. Initial examination revealed 39��C body temperature, mild defense in the upper abdomen and 18.000 mm3 leukocytes. Chest X-rays (Fig. 1, a) and plain abdominal x-rays were normal. Although USS showed no signs of free intraabdominal fluids, the consequent abdominal enhanced computer tomography showed free air and liquid in the retroperitoneal space (Fig.
1, b). Fig. 1 (a, b, c, d) a) Plain abdominal X-ray was negative for free air. b) CT scan shows free air and fluid in retroperitoneal space. c). Intraoperative finding: perforation of the duodenum. d) Single layer suture repair of duodenum. At emergency laparotomy, the Kocher-maneuver revealed a perforation of the second portion of the duodenum (Fig. 1, c). No other injuries were found. We performed single layer suture repair of the duodenum with wide drainage, the abdomen was washed with two liters of warm saline solution (Fig. 1, d). The patient was treated with broad-spectrum antibiotics for 7 days. Cultures taken from the abdomen after prophylactic intravenous antimicrobial therapy remained negative. The nasogastric tube was removed five days after the operation.
Complete oral feeding commenced five days postoperatively. No complications were recorded and the patient was released from hospital 8 days after surgery. Discussion The treatment of duodenal injuries is conditioned on the level of damage and possibility of post-operative complications. Approximately around 72% to 80% of duodenal injuries can be repaired with primary suture and 20�C28% need complex procedure (3, 6). Primary repair of the duodenum is a viable option for the management of limited to moderately severe duodenal injuries. Although more complex and invasive procedures are warranted for management of severe delayed or duodenal disruption. If the duodenal injuries were classified starting from total destruction or not of the duodenal wall, then there would be the duodenal hematoma without perforation, duodenal laceracion and duodenal transection.
Based on that division and the factors determining the gravity of duodenal injuries, we can then determine the proper treatment. The mechanism of GSK-3 trauma in duodenal injuries is explained as having potentially developed from shearing forces or from simultaneous closure of the pylorus and the fourth portion of the duodenum, resulting in increased intraluminal pressure and a ��blowout��.