Surgical management of complex duodenal trauma using laterolateral duodenum enteroanastomosis: A case report

• Published in: International journal of surgery case reports Vol. 89; p. 106648
• Main Authors: Galdino, Dayana Talita, Welter, Carolina da Silveira, Frainer, Djulia Adriani, Theis, Claudia, Haas, Ivana Gabriella Fontana, Fiamoncini, Heloiza
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-12-2021; Elsevier
• Subjects: Case Report; Duodenum; Penetrantig Wounds; Surgical Anastomosis; Surgical procedures; Wounds and injuries; Surgical Anastomosis; Duodenum; Surgical procedures; Wounds and injuries; Penetrantig Wounds; Case Report
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106648

Duodenal trauma is rare, however, it has high morbidity and mortality rates. Surgical treatment modalities are employed depending on severity, ranging from simple sutures to complex pancreaticoduodenectomy cases.
A male patient had a circular saw accident, leading to evisceration in an extensive wound from the thoracoabdominal transition to the inguinal region, with 75% laceration of the second duodenal portion circumference, laceration in hepatic segments, section from right mesocolon to transverse colon, and multiple perforations in small bowel loops between 70 and 90 cm from the angle of Treitz. Laterolateral duodenum enteroanastomosis was performed with proximal jejunum and gastroenteroanastomosis with the distal loop of the small intestine at 90 cm from the Treitz angle, and a termino lateral enteroanastomosis between food and the biliary loop at 20 cm from the gastroenteroanastomosis.
This report presents a new surgical technique for patients with penetrating duodenal trauma associated with liver and intestinal injuries, to avoid the need for more complex procedures. In addition, it demonstrates postoperative management of complications, including confection of the enteroatmospheric fistula for feeding.
The technique described in this article proved to be a good option for treating these lesions, as evidenced by optimal postoperative results.
•Duodenal lesions are challenging to repair due to presentation heterogeneity.•The use of this new technique proved to be a safe alternative.•Despite the complex trauma, the patient evolved well.