Traumatic rupture of duodenal diverticulum-clinical case in catastrophe setting

Abstract

Duodenal diverticula are anatomical outpouchings of the gastrointestinal tract, with a prevalence of up to 27% in individuals over 50 years old. While often asymptomatic, complications such as diverticulitis, obstruction, and perforation can occur. Traumatic rupture of a duodenal diverticulum is extremely rare, with only a few cases documented in the literature. We report the case of a 64-year-old female involved in a major traffic accident with multiple injuries. Initially stable, she later developed abdominal tenderness and hypotension, prompting a CT scan that revealed pneumoperitoneum without significant hemoperitoneum. Surgical exploration revealed a ruptured duodenal diverticulum, which was treated with diverticulectomy and omentoplasty. Blunt abdominal trauma typically affects the liver, spleen, and retroperitoneal organs, while isolated duodenal injuries remain rare. Mechanisms for duodenal rupture, particularly in the context of seatbelt use, include sudden intra-abdominal pressure increases during deceleration. Imaging, particularly CT, plays a crucial role in the early detection of such injuries, although resource limitations during mass casualty events may delay its use. Surgical management remains the definitive treatment, and early intervention is essential in unstable patients. Traumatic rupture of a duodenal diverticulum is an uncommon yet life-threatening event. Early suspicion, timely imaging, and surgical intervention are key to successful outcomes. Continuous reassessment is crucial, as trauma-related injuries may present later in the clinical course.