受傷２週間後に発症した外傷性十二指腸閉塞の１例

概要

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A 20-year-old male was admitted with blunt injury to the abdomen. Radiological procedures, chest and abdominal X-ray studies,and CT scan revealed no overt abnormal findings.The initial symptoms,epigastric pain and vomiting, disappeared 3 days after starting conservative therapy involving fasting, intravenous fluid and nasogastric decompression. The patient was discharged 10 days after suffering the injury, but was readmitted because of frequent vomiting a few days later. Obstruction of the third portion of the duodenum was confirmed by upper gastroduodenography. Abdominal CT showed expansion of the stomach, bulbus and descending part of the duodenum, but no hematoma was found. Surgery was required because of the failure of conservative therapy and of balloon extension of the stenosis. Gastrojejunal anastomosis and Braun's anastomosis were performed, and the obstructive symptoms improved. In this case, late obstruction of the duodenum developed because of fibrosis of the latter. Neither intramural duodenal hematoma nor retroperitoneal hematoma was detected. Micro-inflammation of the duodenum after the injury is thought to have been the ultimate cause of the delayed obstruction.
信州医学会の論文