بسم الله الرحمن الرحيم السلام عليكم Today’s discussion about duodenal trauma starts with a case presentation This was a …
Falling off a cargo In the parent’s own words
rather than penetrating injuries that usually necessitates urgent exploration
Assistant Lecturerof Pediatric Surgery
Male child aged 6 years.
Presented with history of abdominal
pain and repeated vomiting, gastric
in nature at first then became bilious
that started 48 hours ago.
With further and thorough history
taking, the parents mentioned a
history of blunt abdominal trauma.
The parents sought medical advice,
ultrasound was requested and
showed biliary sludge with no other
So, Diagnosis of acute cholecystitis
The patient didn’t improve on medical
Ultrasound was repeated, showing an
Examination & investigations
When the patient presented to us:
Examination showed diffuse
abdominal tenderness mainly epigastric.
No mass was felt clinically.
Ultrasound was repeated and showed
query duodenal hematoma, CTabdomen
and pelvis followed U/S confirming the
Duodenal injuriesareuncommon and both difficult to
Diagnosisismoredifficult in blunt injuriesand requires
high index of suspicion.
No specific diagnostic test found to be accurate all of the
Intra-op findingsthat requireexploration:
Crepitusalong theduodenal sweep
Bilestaining of paraduodenal or adjacent tissues
Right-sided retroperitoneal or periduodenal hematoma