INTRESTING CASE - TRAUMA CASE-DELAYED PRESENTATION OF COMPLETE DUODENAL TRANSECTION

Trauma case - Delayed Presentation of Complete Duodenal Transection
A 25-year-old male presented with severe abdominal pain of 20 days duration following blunt abdominal trauma(Cricket). Initial CECT abdomen at a local hospital revealed hemoperitoneum, and he was managed conservatively for 14 days. Persistent symptoms led to evaluation by a gastroenterologist, where conservative management was continued for another 4 days. Repeat CECT demonstrated suprapubic and right perinephric/psoas collections with airfoci, following which suprapubic and right flank pigtail  drains were placed by a urologist.
The patient subsequently presented to our institute with features of generalized peritonitis and severe abdominal pain. Exploratory laparotomy revealed:
* Complete transection at junction of 3rd and 4th  part of the duodenum
* Ceacum, Ascending Colon and Hepatic flexure were injured by the pancreatic secretions.
* Extensive frank pus collection in the right retroperitoneal/perinephric space and extending into the pelvis. 
Procedures performed:
* End-to-end duodenal anastomosis
* Reinforcement with jejunal serosal patch
* Decompressive Tube Duodenostomy.
* Right hemicolectomy with ileo-transverse colon anastomosis
* Thorough peritoneal lavage and drainage
Postoperatively, the patient was managed in SICU. He was successfully extubated yesterday and is currently hemodynamically stable.
 I am thankful to my assistant professor and post graduates for assisting me in this major rare case and also thankful to the Dept., of Anesthesia for giving prolonged comfortable anesthesia for this rare procedure.