Garside Graham, Khan Omar, Mukhtar Zahid, Sinha Chandrasen
St George's University of London, London, UK.
Department of Upper GI and Bariatric Surgery, St George's Hospital, London, UK.
BMJ Case Rep. 2018 Aug 29;2018:bcr-2018-225221. doi: 10.1136/bcr-2018-225221.
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.
我们报告一例11岁男孩因钝性车把创伤继发十二指肠穿孔合并胆总管破裂的迟发性病例。患者表现为上腹壁瘀斑、疼痛和呕吐。24小时后症状缓解出院。然而，该男孩在2天后出现发热及腹膜炎体征。CT显示十二指肠穿孔，剖腹探查时证实存在十二指肠穿孔，同时也发现了胆总管破裂。对十二指肠进行了一期修复。在此，通过在损伤近端放置鼻胃管和在远端进行T管十二指肠造口术实现减压。通过胆道支架完成胆总管修复。该病例代表了十二指肠损伤的一个罕见亚型，目前关于其最佳手术治疗的证据匮乏，尤其是在儿科患者中。该手术方案将为外科医生和初级医生未来处理此类复杂病例提供指导。
