Isolated Pyloroduodenal Transection in Children: a Spectrum of Presentation of an Uncommon Entity

Abstract

Isolated duodenal injuries are not commonly seen in children who sustain abdominal trauma, and a complete pyloroduodenal disruption is quite rare. While techniques of duodenal diverticulization are employed widely in adults, the application of intubated diversion with primary repair works just as well in children. Two cases of isolated pyloroduodenal transection have been chronicled. To the best of our knowledge, one of these is the first case of successfully treated complete pyloroduodenal disjunction in pediatric literature. Case 1: A 10-year-old boy sustained multiple injuries after a road traffic accident and presented to us 48-h post-incident. Imaging suggested a duodenal injury. Exploratory laparotomy revealed a complete pyloroduodenal transection without associated pancreatic/ductal injuries. Primary repair with intubated diversions and a feeding jejunostomy was done. The child recovered completely. Case 2: A 5-year-old girl with delayed presentation following a road traffic accident required cardiopulmonary resuscitation and inotropic support prior to exploratory laparotomy. Findings included a large retroperitoneal hematoma involving zone 1 and 2, a right hepatic laceration, gastroduodenal disruption, and impending venous gangrene of the bowel. Intraoperative cardiac arrest necessitated rapid damage control surgery. Unfortunately, the child did not survive the injury. We wish to emphasize not only the need for early diagnosis and the customization of the surgery depending on the site and extent of injury but also the necessity of the rapid establishment of enteral nutrition to enhance recovery.