Traumatic Duodenal Injury Presenting as a Slight Retroperitoneal Hematoma around the Treitz ligament: A Case Report
Duodenal injury in abdominal trauma is relatively rare. Early diagnosis is difficult, compared to other gastrointestinal tract injuries, because the duodenum is located in the retroperitoneum. When this condition is not diagnosed early, serious complications like suture failure may occur postoperati...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 26; no. 1; pp. 63 - 67 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
2006
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem1993.26.63 |
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| Abstract | Duodenal injury in abdominal trauma is relatively rare. Early diagnosis is difficult, compared to other gastrointestinal tract injuries, because the duodenum is located in the retroperitoneum. When this condition is not diagnosed early, serious complications like suture failure may occur postoperatively because of the effects of bile or pancreatic juice. A 45-year old man was admitted for blunt abdominal trauma. An abdominal CT scan did not reveal the presence of air or fluid collection in the retroperitoneal cavity around the duodenum one hour after, the blunt abdominal injury. During an emergency laparotomy for the treatment of other injured organs, a slight hematoma around the Treitz ligament in the retroperitoneum was found. We mobilized the duodenum and found a perforation in the 4th portion of the duodenum. A duodenorrhaphy was subsequently performed. No serious complications occurred during the postoperative course. |
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| AbstractList | Duodenal injury in abdominal trauma is relatively rare. Early diagnosis is difficult, compared to other gastrointestinal tract injuries, because the duodenum is located in the retroperitoneum. When this condition is not diagnosed early, serious complications like suture failure may occur postoperatively because of the effects of bile or pancreatic juice. A 45-year old man was admitted for blunt abdominal trauma. An abdominal CT scan did not reveal the presence of air or fluid collection in the retroperitoneal cavity around the duodenum one hour after, the blunt abdominal injury. During an emergency laparotomy for the treatment of other injured organs, a slight hematoma around the Treitz ligament in the retroperitoneum was found. We mobilized the duodenum and found a perforation in the 4th portion of the duodenum. A duodenorrhaphy was subsequently performed. No serious complications occurred during the postoperative course.
腹部外傷中, 十二指腸損傷の頻度は比較的まれであるが, 早期診断できなかった場合, 胆汁, 膵液の影響で術後に縫合不全などの重篤な合併症を引き起こしやすいという点で, 重要な疾患である. 今回われわれは腹部外傷受傷直後のCTでは十二指腸損傷を疑わせる所見を認めなかったが他臓器損傷のため開腹した際, 十二指腸周囲の後腹膜に軽度血腫を認めたため十二指腸を授動したところ, 十二指腸forth portionに穿孔を発見した症例を経験したので, 報告する. Duodenal injury in abdominal trauma is relatively rare. Early diagnosis is difficult, compared to other gastrointestinal tract injuries, because the duodenum is located in the retroperitoneum. When this condition is not diagnosed early, serious complications like suture failure may occur postoperatively because of the effects of bile or pancreatic juice. A 45-year old man was admitted for blunt abdominal trauma. An abdominal CT scan did not reveal the presence of air or fluid collection in the retroperitoneal cavity around the duodenum one hour after, the blunt abdominal injury. During an emergency laparotomy for the treatment of other injured organs, a slight hematoma around the Treitz ligament in the retroperitoneum was found. We mobilized the duodenum and found a perforation in the 4th portion of the duodenum. A duodenorrhaphy was subsequently performed. No serious complications occurred during the postoperative course. |
| Author | Aizawa, Kikuo Kiyonaga, Hidetoshi Morioka, Nobuhiro Miyashita, Kaoru |
| Author_FL | 森岡 伸浩 宮下 薫 藍澤 喜久雄 清永 英利 |
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| DocumentTitleAlternate | 軽度の後腹膜血腫が発見の契機となった外傷性十二指腸損傷の１例 |
| DocumentTitle_FL | 軽度の後腹膜血腫が発見の契機となった外傷性十二指腸損傷の１例 |
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| References | 18) 和久利彦, 渡辺和彦, 富岡憲明, ほか: 鈍的外傷による十二指腸損傷の3例. 日臨外会誌2004; 65: 395-399. 14) 中村達也, 村尾佳則, 宮本誠司, ほか: 腹部鈍的外傷による十二指腸・小腸穿孔例の検討手術決定のためのCT画像診断-. 日腹部救急医会誌1993; 13: 727-731. 6) Fish JC, Johnson GL: Rupture of duodenum following blunt trauma. Report of a case with avulsion of papilla of Vater. Ann Surg 1963; 162: 917-922. 8) 菊野隆明, 浅利靖, 瀧島常雄, ほか: 鈍的十二指腸破裂の診断・治療の臨床的検討. 日外傷研会誌1992; 6: 289-296. 1) Sung CK, Kim KH: Missed injury in abdominal trauma. J Trauma 1996; 41: 276-278. 10) 小暮公孝, 中村卓次, 松沢達治, ほか: 外傷性十二指腸破裂の臨床. 外科1979; 41: 577-587. 13) 西巻博, 堀池重治, 浅利靖, ほか: 鈍的外傷による十二指腸損傷のCT像の検討. 日外傷会誌1994; 8: 337-344. 15) 山吉隆友, 伊藤重彦, 木戸川秀生, ほか: 鈍的外傷による十二指腸損傷例の検討特にCT所見と手術法について. 日外傷会誌2001; 15: 246-250. 2) 安田是和: 十二指腸損傷の原因と実態 (臨床統計). 外科1994; 56: 795-799. 17) 奥村拓也, 鈴木昌八, 竹原康雄, ほか: MRIにて外傷性十二指腸穿孔を早期診断した1例. 日腹部救急医会誌2000; 20: 1055-1059. 16) 町田雪乃: 腸管損傷における腹部CTの有用性の検討. 聖マリアンナ医大誌1997; 25: 619-631. 9) 浦英樹, 浅井康文, 江副英理, ほか: 外傷性膵・十二指腸損傷23例の臨床的検討. 日腹部救急医会誌2001; 21: 1341-1346. 5) Cocke WM, Mayer KK: Retroperitoneal duodenal rupture-proposed mechanism, review of literature and report of a case. Am J Surg 1964; 108: 834-839. 12) 山本修三, 宮川健, 茂木正寿, ほか: 十二指腸後腹膜破裂術前診断と空腸漿膜パッチ法を中心として. 日救急医会誌1976; 3: 91-98. 11) 矢吹清隆, 渡部洋三, 津村秀憲, ほか: 外傷1生十二指腸腸破裂の検討. 腹部救急診療の進歩1992; 12: 857-861. 19) 茂木正寿, 山本修三, 篠沢洋太郎, ほか: 腹部外傷中診断のpitfall. 消外1983; 6: 1764-1765. 4) Felson B, Levein EJ: Intramural hematoma of the duodenum. A diagnostic roetgen sign. Radiology 1954; 63: 823-831. 7) Roman E, Silva YJ, Lucas C: Management of blunt duodenal injury. Surg Gynecol Obstet 1971; 132: 7-14. 3) 加来信雄: 十二指腸損傷. 救急医1990; 14: 1620-1623. |
| References_xml | – reference: 15) 山吉隆友, 伊藤重彦, 木戸川秀生, ほか: 鈍的外傷による十二指腸損傷例の検討特にCT所見と手術法について. 日外傷会誌2001; 15: 246-250. – reference: 8) 菊野隆明, 浅利靖, 瀧島常雄, ほか: 鈍的十二指腸破裂の診断・治療の臨床的検討. 日外傷研会誌1992; 6: 289-296. – reference: 10) 小暮公孝, 中村卓次, 松沢達治, ほか: 外傷性十二指腸破裂の臨床. 外科1979; 41: 577-587. – reference: 4) Felson B, Levein EJ: Intramural hematoma of the duodenum. A diagnostic roetgen sign. Radiology 1954; 63: 823-831. – reference: 17) 奥村拓也, 鈴木昌八, 竹原康雄, ほか: MRIにて外傷性十二指腸穿孔を早期診断した1例. 日腹部救急医会誌2000; 20: 1055-1059. – reference: 7) Roman E, Silva YJ, Lucas C: Management of blunt duodenal injury. Surg Gynecol Obstet 1971; 132: 7-14. – reference: 9) 浦英樹, 浅井康文, 江副英理, ほか: 外傷性膵・十二指腸損傷23例の臨床的検討. 日腹部救急医会誌2001; 21: 1341-1346. – reference: 16) 町田雪乃: 腸管損傷における腹部CTの有用性の検討. 聖マリアンナ医大誌1997; 25: 619-631. – reference: 3) 加来信雄: 十二指腸損傷. 救急医1990; 14: 1620-1623. – reference: 12) 山本修三, 宮川健, 茂木正寿, ほか: 十二指腸後腹膜破裂術前診断と空腸漿膜パッチ法を中心として. 日救急医会誌1976; 3: 91-98. – reference: 2) 安田是和: 十二指腸損傷の原因と実態 (臨床統計). 外科1994; 56: 795-799. – reference: 14) 中村達也, 村尾佳則, 宮本誠司, ほか: 腹部鈍的外傷による十二指腸・小腸穿孔例の検討手術決定のためのCT画像診断-. 日腹部救急医会誌1993; 13: 727-731. – reference: 18) 和久利彦, 渡辺和彦, 富岡憲明, ほか: 鈍的外傷による十二指腸損傷の3例. 日臨外会誌2004; 65: 395-399. – reference: 13) 西巻博, 堀池重治, 浅利靖, ほか: 鈍的外傷による十二指腸損傷のCT像の検討. 日外傷会誌1994; 8: 337-344. – reference: 11) 矢吹清隆, 渡部洋三, 津村秀憲, ほか: 外傷1生十二指腸腸破裂の検討. 腹部救急診療の進歩1992; 12: 857-861. – reference: 6) Fish JC, Johnson GL: Rupture of duodenum following blunt trauma. Report of a case with avulsion of papilla of Vater. Ann Surg 1963; 162: 917-922. – reference: 19) 茂木正寿, 山本修三, 篠沢洋太郎, ほか: 腹部外傷中診断のpitfall. 消外1983; 6: 1764-1765. – reference: 1) Sung CK, Kim KH: Missed injury in abdominal trauma. J Trauma 1996; 41: 276-278. – reference: 5) Cocke WM, Mayer KK: Retroperitoneal duodenal rupture-proposed mechanism, review of literature and report of a case. Am J Surg 1964; 108: 834-839. |
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| Title | Traumatic Duodenal Injury Presenting as a Slight Retroperitoneal Hematoma around the Treitz ligament: A Case Report |
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