Complete transection of third part of duodenum following blunt injury abdomen: a rare case report

Noufal Thekkekara Basheer, Jothiprasad Venkatesan, Amaradeepthi Pravallika, Sureeskumar Subramaniam, Venugopal Sarveswaran


Blunt injury abdomen (BIA) is an ever-increasing problem. Isolated injury to duodenum following BIA is rare (1-4%). It can be a challenge to the surgeon and failure to manage it properly can lead on to devastating results. Blunt duodenal injury can occur in isolation or with pancreatic injury. We report a case of an isolated transection of third part of the duodenum following BIA. Initial clinical changes in isolated duodenal injury may be subtle before life-threatening peritonitis develops. High index of suspicion, knowledge of mechanism of injury, physical examination and proper imaging techniques are the key in early detection of duodenal injury.


Blunt injury abdomen, Isolated duodenal injury, Duodenorrhaphy, Duodenostomy

Full Text:



Delayed diagnosis of blunt duodenal injury: An avoidable complication. J Am Coll Surg. 1998;187:3393-9.

Kambaroudis A, Antoniadis N, Papadopoulos S, Spiridis C, Gerasimidis T. Reconstruction of a traumatic duodenal transection with a pedicled ileal loop. J Med Case Reports. 2010;4:343.

Cone JB, Eidt JF. Delayed diagnosis of duodenal rupture. Am J Surg. 1994;168:676-8.

Lucas CE, Ledgerwood AM. Factors influencing outcome after blunt duodenal injury. J Trauma. 1975;15:839-46.

Blocksom JM, Tyburski JG, Sohn RL, Williams M, Harvey E, Steffes CP, et al. Prognostic determinants in duodenal injuries. Am Surg. 2004;70:248-55.

Bozkurt B, Ozdemir BA, Kocer B, Unal B, Dolapci M, Cengiz O. Operative approach in traumatic injuries of the duodenum. Acta Chir Belg. 2006;106:4405-8.

Morton JR, Jordan GL. Traumatic duodenal injuries: review of 131 cases. J Trauma. 1968;8:127-39.

Smith AD, Woolverton WC, Weichert RF, Drapanas T. Operative management of pancreatic and duodenal injuries. J Trauma. 1971;14:570-9.

McInnis WD, Aust JB, Cruz AB, Root HD. Traumatic injuries of the duodenum: a comparison of primary closure and the jejunal patch. J Trauma. 1975;15:847-53.

Corley RD, Nocross WJ, Shoemacker WC. Traumatic injuries to the duodenum: a report of 98 patients. Ann Surg. 1974;181:92-8.

Asensio JA, Feliciano DV, Britt LD, Kerstein MD, management of duodenal injuries. Curr Probl Surg. 1993;30:1023.

Olsen WR. The serum amylase in blunt abdominal trauma. J Trauma. 1973;13:201-4.

Felson B, Levin EJ. Intramural hematoma of the duodenum: a diagnostic roentgen sign. Radiology. 1954;63:823-31.

Ballard R, Badellino M, Eynon A, Spott MA, Staz CF, Buckman RF. Blunt duodenal rupture: a 6 years state wide experience. J Trauma. 1997;43:229-33.

Moore EE, Cogbill TH, Malongoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling. II. Pancreas, duodenum, small bowel, colon and rectum. J Trauma. 1990;30:1427-9.

Snyder WH, Weigelt JA, Watkins WL, Bietz DS. The surgical management of duodenal trauma. Arch Surg. 1980;115:422-9.

Berne CJ, Donovan AJ, Hagen WE. Combined duodenal pancreatic trauma: the role of end-to-side gastrojejunostomy. Arch Surg. 1968;96:712-22.

Seamon MJ, Pieri PG, Fisher CA, Gaughan J, Santora TA, Pathak AS, et al. A ten years retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries. J Trauma. 2007;62:829-33.

Kobbold EE, Thal AP. A simple method for the management of experimental wounds to the duodenum. Surg Gynecol Obstet. 1963;116:340-4.

Thal AP, Wilson RF. A pattern of severe blunt trauma to the region of the pancreas. Surg Gynecol Obstet. 1964;119:773-8.