Duodenal Traumain Pediatrics

Presented by:Mahmoud Motawea

Assistant Lecturer of Pediatric Surgery

History

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.

History

The parents sought medical advice, ultrasound was requested and showed biliary sludge with no other abnormalities. So, Diagnosis of acute cholecystitis was considered.

History

The patient didn’t improve on medical treatment.

Ultrasound was repeated, showing an epigastric mass.

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, CT abdomen and pelvis followed U/S confirming the diagnosis.

Examination & investigations

Examination & investigations

Examination & investigations

Examination & investigations

Surgical intervention

Surgical intervention

Surgical intervention

Home Message

Duodenal injuries are uncommon and both difficult to diagnose and repair.

Diagnosis is more difficult in blunt injuries and requires high index of suspicion.

No specific diagnostic test found to be accurate all of the time.

Intra-op findings that require exploration: Crepitus along the duodenal sweep Bile staining of paraduodenal or adjacent

tissues Right-sided retroperitoneal or periduodenal

hematoma