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Clinical Suspicion in Delayed Isolated Duodenal Perforation in a Child: A Case Report | ||
| Al- Anbar Medical Journal | ||
| Volume 22, Issue 1, January 2026, Pages 52-55 PDF (2.58 M) | ||
| Document Type: Case reports | ||
| DOI: 10.33091/amj.2025.164070.2389 | ||
| Authors | ||
| Semaa Mohammed alhasnawi* 1; Sawsan M Jabbar AL-Hasnawi2 | ||
| 1Department of Surgery/Paediatric Surgery, College of Medicine, University of Kerbala, Karbala, Iraq. | ||
| 2Department of Microbiology, College of Medicine, University of Kerbala, Karbala, Iraq. | ||
| Abstract | ||
| After blunt abdominal trauma, severe injuries to the duodenum are rare but can be serious. As the duodenum lies retroperitoneally, perforation may not cause noticeable symptoms, leading to delayed diagnosis. Isolated duodenal perforation (IDP) is difficult to diagnose due to nonspecific symptoms. Early detection with a computed tomography (CT) scan is fundamental for saving lives. In prior studies, approximately 100 cases of IDP in children have been reported. The present study highlights the high index of clinical suspicion, along with the crucial role of the CT scan in detecting this injury. A 7-year-old boy arrived with worsening right abdominal pain, fever, and vomiting 9 days after a road traffic accident. Upon admission, leukocytosis (28.44 ×10³/µL) and contrast-enhanced abdominal CT findings revealed retroperitoneal free air and suspected bowel perforation. Exploratory laparotomy confirmed a 3 cm duodenal perforation, repaired by two-layer duodenorrhaphy and omental patch. Postoperative recovery was successful with multidisciplinary care. Therefore, isolated duodenal perforation warrants a high degree of suspicion in pediatric patients with blunt trauma. Early contrast-enhanced abdominal CT and prompt surgical intervention are crucial to reduce morbidity and mortality. | ||
| Keywords | ||
| Case report; Isolated duodenal perforation; Delayed diagnosis; Contrast-enhanced computed tomography scan; Duodenography | ||
| References | ||
|
[1] M. Bašković, D. Keretić, M. Lacković, M. Borić Krakar, and Z. Pogorelić, "The Diagnosis and Management of Pediatric Blunt Abdominal Trauma—A Comprehensive Review," Diagnostics, vol. 14, no. 20, p. 2257, 2024.
[2] R. A. Wani and S. S. Sen, "Isolated Duodenal Injury in Blunt Abdominal Trauma in Children: A Series of Five Cases," African Journal of Paediatric Surgery, vol. 21, no. 4, pp. 267-270, 2024.
[3] S. Qarouach, L. Aqqaoui, C. Riadi, H. Zitan, and H. Oubejja, "Post-traumatic duodenal perforation in a 15-year-old adolescent: Case report," J Clin Images Med Case Rep, vol. 6, no. 8, p. 3742, 2025.
[4] S. Huerta, T. Bui, D. Porral, S. Lush, and M. Cinat, "Predictors of morbidity and mortality in patients with traumatic duodenal injuries," The American Surgeon, vol. 71, no. 9, pp. 763-767, 2005.
[5] B. Goh and S. S. Soundappan, "Traumatic duodenal injuries in children: a single‐centre study," ANZ journal of surgery, vol. 91, no. 1-2, pp. 95-99, 2021.
[6] B. Gosangi, T. C. Rocha, and A. Duran-Mendicuti, "Imaging spectrum of duodenal emergencies," Radiographics, vol. 40, no. 5, pp. 1441-1457, 2020.
[7] F. Coccolini et al., "Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines," World Journal of Emergency Surgery, vol. 14, no. 1, p. 56, 2019.
[8] Z. Cheng, Y. Zheng, J. Gao, Z. Wu, Q. Feng, and B. Wang, "Management of traumatic duodenal rupture in children-case series," BMC pediatrics, vol. 24, no. 1, p. 742, 2024.
[9] N. Antonacci et al., "Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?," Journal of Hepato‐Biliary‐Pancreatic Sciences, vol. 18, no. 2, pp. 195-201, 2011.
[10] E. G. Santos, A. S. Sánchez, J. M. Verde, C. P. Marini, J. A. Asensio, and P. Petrone, "Duodenal injuries due to trauma: review of the literature," Cirugía Española (English Edition), vol. 93, no. 2, pp. 68-74, 2015.
[11] Y. Luo et al., "Diagnosis and treatment of traumatic duodenal rupture in children," BMC gastroenterology, vol. 22, no. 1, p. 61, 2022.
[12] K. J. K. Gunarathne, P. J. Kaushalya, and N. W. Halpegamage, "A delayed presentation of a traumatic isolated duodenal injury," SAGE Open Medical Case Reports, vol. 11, p. 2050313X231169848, 2023.
[13] A. Ratnasekera and P. Ferrada, "Traumatic duodenal injury: current management update," Current surgery reports, vol. 8, no. 5, p. 6, 2020. | ||
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