Case presentation of a rare case pf pediatric duodenal trauma

2. Duodenal Trauma
in Pediatrics
Presented by:
Mahmoud Motawea
Assistant Lecturerof Pediatric Surgery

3. History
 Male child aged 6 years.
 Presented with history of abdominal
pain and repeated vomiting, gastric
in nature at first then became bilious
that started 48 hours ago.
 With further and thorough history
taking, the parents mentioned a
history of blunt abdominal trauma.

4. History
 The parents sought medical advice,
ultrasound was requested and
showed biliary sludge with no other
abnormalities.
 So, Diagnosis of acute cholecystitis
was considered.

5. History
 The patient didn’t improve on medical
treatment.
 Ultrasound was repeated, showing an
epigastric mass.

6. Examination & investigations
When the patient presented to us:
Examination showed diffuse
abdominal tenderness mainly epigastric.
No mass was felt clinically.
Ultrasound was repeated and showed
query duodenal hematoma, CTabdomen
and pelvis followed U/S confirming the
diagnosis.

7. Examination & investigations

8. Examination & investigations

9. Examination & investigations

10. Examination & investigations

11. Surgical intervention

12. Surgical intervention

13. Surgical intervention

14. HomeMessage
Duodenal injuriesareuncommon and both difficult to
diagnoseand repair.
Diagnosisismoredifficult in blunt injuriesand requires
high index of suspicion.
No specific diagnostic test found to be accurate all of the
time.
Intra-op findingsthat requireexploration:
 Crepitusalong theduodenal sweep
 Bilestaining of paraduodenal or adjacent tissues
 Right-sided retroperitoneal or periduodenal hematoma