Open AccessPaediatric duodenal injury complicated by common bile duct rupture due to blunt trauma: a multispecialist approach
Author(s) -
Graham Garside,
Omar Khan,
Zulfikri Mukhtar,
Chandni Sinha
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-225221
Subject(s) - medicine , common bile duct , surgery , duodenum , laparotomy , abdominal trauma , ecchymosis , blunt , abdominal pain , bile duct , vomiting , blunt trauma , perforation , general surgery , punching , materials science , metallurgy
We report a case of late presenting duodenal perforation with common bile duct rupture secondary to blunt handlebar trauma in an 11-year-old boy. The patient presented with upper abdominal wall ecchymosis, pain and vomiting. He was discharged after 24 hours with resolving symptoms. However, the boy presented 2 days later febrile with signs of peritonitis. CT indicated duodenal perforation, which was confirmed during laparotomy where common bile duct rupture was also demonstrated. Primary repair of the duodenum was undertaken. Here, decompression was achieved with a nasogastric tube proximal to the injury and T-tube duodenostomy distally. Common bile duct repair was achieved over a biliary stent. This case represents a rare subset of duodenal injury for which there is a paucity of evidence for optimal surgical management, particularly in the paediatric setting. This operative plan will guide surgeons and junior doctors in managing complicated cases like this in future.