title: Isolated blunt duodenal trauma: delayed diagnosis and favorable outcome with "quadruple tube" decompression.
abstract: BACKGROUND
  Isolated blunt duodenal injury is a rare finding associated with high morbidity and significant mortality. The early identification of a duodenal injury is usually difficult, considering the anatomical location of the duodenum and lack of peritoneal signs and diagnostic delay is part of the clinical picture in most cases.
  
  
  METHODS
  A 43-year-old man was admitted to our hospital after a motor vehicle collision. At admission he underwent emergency surgery because of lower extremities fractures. Twelve hours later he started to complain an increasing abdominal pain; blood tests showed serum amylase up to 180 U/L and a CT scan demonstrated a perforation of the third duodenal portion. At laparotomy a Grade III injury of the duodenum was evident. The laceration was sutured and a "quadruple-tube" decompression was performed. The postoperative course was uneventful. One year after surgery he is well without any long-term complication.
  
  
  CONCLUSIONS
  A high degree of suspicion is necessary for early diagnosis of blunt duodenal trauma and CT scan should be performed in case of all significant epigastric trauma. In most cases primary direct repair of duodenal wounds can be safely achieved and duodenal decompression via triple or quadriple tube technique is required to decrease the risk of duodenal fistula.
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy. massimo.falconi@univr.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.forename: Rossella
authors.initials: R
authors.lastname: Bettini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barugola
authors.forename: Silvia
authors.initials: S
authors.lastname: Germenia
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*