Guanà R, Sangiorgio L, Tessiatore P, Seymandi P
Santi Antonio e Biagio and Cesare Arrigo Hospital, Alessandria, Italy.
Minerva Pediatr. 2012 Feb;64(1):47-53.
Two consecutive children, motor vehicle accident victims, were treated between December 2006 and January 2007. They reported duodenal perforations due to lap-belt action. In the first case (a 9-year-old boy), symptoms became immediately evident after the trauma. Early computerized tomography (CT) scan demonstrated biliaryhemoperitonitis and free sub-diaphragmatic air. At the laparotomy a complete duodenal transection, at the level of duodenal bulb, was found. In the second patient, early X-ray and CT scan revealed no free abdominal air; only the second CT scan, repeated after 48 hours, when general conditions of the girl become critical, demonstrated biliary peritonitis and aerial extraluminal gas image in the right peri-kidney space. At the surgical exploration a duodenal laceration was noted, at the passage between the second and the third duodenal portion, in the postero-lateral wall, with an extension of 6 cm. In both children direct suture of duodenal injury without stoma construction was performed. Not early or late postoperative complications were registered (follow-up: 18 months). In the traumatic duodenal lesions an early diagnosis is not always possible because of the paucity of the clinical signs. Tightened clinical and radiological monitoring of the patient is fundamental in the successive hours to the trauma. Early diagnosis and high level of suspicious rest crucial for better prognosis in this group of patients.
2006年12月至2007年1月期间，对两名连续因机动车事故受伤的儿童进行了治疗。他们均因安全带作用导致十二指肠穿孔。第一例（一名9岁男孩），创伤后症状立即显现。早期计算机断层扫描（CT）显示胆汁性腹膜炎和膈下自由气体。剖腹手术时发现十二指肠球部完全横断。第二例患者，早期X线和CT扫描未发现腹腔内自由气体；仅在48小时后重复进行的第二次CT扫描时，该女孩的一般情况变得危急，显示出胆汁性腹膜炎和右肾周间隙的腔外气体影像。手术探查时发现十二指肠在第二和第三部分之间的后外侧壁有一处撕裂伤，长度为6厘米。两名儿童均进行了十二指肠损伤的直接缝合，未造瘘。术后未出现早期或晚期并发症（随访：18个月）。在外伤性十二指肠损伤中，由于临床体征较少，早期诊断并非总是可行。在创伤后的连续数小时内，对患者进行严密的临床和放射学监测至关重要。早期诊断和高度怀疑对于该组患者的更好预后至关重要。
