Awedew Atalel Fentahun, Setargew Kidist Hunegn, Tebkew Andualem Dagne, Emiru Zemen Asmare
Department of Surgery, SOM, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Surgery, SOM, Debre Tabor University, Debre Tabor, Ethiopia.
Int J Surg Case Rep. 2025 Aug;133:111521. doi: 10.1016/j.ijscr.2025.111521. Epub 2025 Jun 14.
Duodenal perforation poses a significant global health challenge, contributing substantially to morbidity, mortality, and hospitalizations. While most perforations occur in the first part of the duodenum, are typically small, and affect older individuals, giant perforations in the second part of the duodenum are exceedingly rare.
A 20-year-old male patient presented with a three-day history of diffuse abdominal pain, accompanied by nausea, vomiting, and anorexia of similar duration. The physical examination revealed PR = 104, BP = 110/70 mmHg and diffuse abdominal tenderness. A significant intraoperative finding was a 5 × 6 cm perforation in the second portion of the duodenum, with leakage of gastrointestinal and biliary contents consistent with biliary peritonitis. A pyloric exclusion, retrocolic gastrojejunostomy, and duodenal repair were performed.
Perforations in the second part of the duodenum are considerably rarer. However, when perforation does occur, particularly in the second part of the duodenum, management presents significant challenges, often associated with high rates of morbidity and mortality. Our patient presented with one the high-risk factors-delayed presentation-and, based on established risk stratification models, would therefore carry an estimated mortality risk of approximately 10 %. There is currently a paucity of definitive guidelines or strong expert consensus regarding the optimal surgical approach for giant duodenal perforations located in the second part. In our patient's case, we performed a repair of the perforation, pyloric exclusion, and retrocolic gastrojejunostomy.
Perforation of the second part of the duodenum is a rare occurrence and presents significant management challenges in emergency situations.
十二指肠穿孔是一项重大的全球健康挑战，在发病率、死亡率和住院率方面造成了巨大影响。虽然大多数穿孔发生在十二指肠第一部，通常较小，且影响老年个体，但十二指肠第二部的巨大穿孔极为罕见。
一名20岁男性患者，有三天弥漫性腹痛病史，伴有持续时间相似的恶心、呕吐和厌食。体格检查显示脉搏（PR）=104，血压（BP）=110/70 mmHg，全腹压痛。术中一个重要发现是十二指肠第二部有一个5×6 cm的穿孔，胃肠道和胆汁内容物渗漏，符合胆汁性腹膜炎。进行了幽门旷置、结肠后胃空肠吻合术和十二指肠修复术。
十二指肠第二部的穿孔相当罕见。然而，当穿孔确实发生时，特别是在十二指肠第二部，治疗面临重大挑战，往往伴随着高发病率和死亡率。我们的患者存在一个高危因素——就诊延迟——并且根据既定的风险分层模型，因此估计有大约10%的死亡风险。目前对于位于十二指肠第二部的巨大穿孔的最佳手术方法，缺乏明确的指南或强有力的专家共识。在我们患者的病例中，我们进行了穿孔修复、幽门旷置和结肠后胃空肠吻合术。
十二指肠第二部穿孔是一种罕见情况，在紧急情况下带来重大治疗挑战。
