Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3271
Peer-review started: June 29, 2019
First decision: July 31, 2019
Revised: September 18, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: October 26, 2019
Processing time: 121 Days and 1 Hours
A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy, but is not typically an indication for endoscopic treatment.
A 27-year-old man visited the emergency department with a self-inflicted abdominal stab wound. Injuries to the colon and ileum were detected, but an injury to the second portion of the duodenum was missed. On the day following admission to our institution, the patient became hemodynamically unstable with massive hematochezia, although there was no evidence of bleeding in the Levin tube or Jackson-Pratt drain. We thus performed an upper gastrointestinal endoscopy and discovered a missed duodenal injury that was actively bleeding. An endoscopic band ligation was performed for hemostasis and closure of the perforation. The patient was subsequently discharged without any complications.
A penetrating injury of the duodenum can be overlooked, so careful abdominal exploration is very important. If a missed duodenal injury is suspected, a cautious endoscopic approach may be helpful.
Core tip: Following a penetrating abdominal injury, it is very important for surgeons to find all associated lesions. Insufficient abdominal exploration can result in a missed injury, occasionally leading to the need for reoperation and possibly a fatal outcome. We successfully treated a rare case of perforation and bleeding in the third portion of the duodenum, which was not found by upper-abdominal exploration during the initial surgery. If a missed hollow viscus injury, particularly in the duodenum, remains despite such efforts, an endoscopic approach may be helpful in some cases.