Isolated duodenal rupture: primary repair without diversion; is it safe? Review of literature

Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the associated morbidity and mortality. The debate is about the optimum operative management. We report a 6-year-old child who presented with acute abdominal pain due to isolated duodenal injury following blunt abdominal trauma. Emergency laparotomy revealed duodenal rupture at the junction of the first and second part of duodenum and absence of any other visceral injuries. The duodenal injury was defined as grade III, that is, involving 75% of the circumference. We opted to perform primary repair of the injured duodenum in two layers alone without diversion. The abdominal cavity was drained using an open system drain next to the repair. Nasogastric and jejunostomy tubes were used postoperatively for gastric decompression and enteral feeding, respectively. The child had an uneventful recovery, was discharged well on the 10th postoperative day and no stenosis was found on long-term follow-up. The debate was whether to repair the defect primarily or to combine the repair with diversion. Early diagnosis, the isolated nature of the duodenal injury and the possibility of minimal contamination favoured primary repair of the defect without diversion. The good outcome attributed to these factors were in agreement with most of the literature.

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