A modified approach to decompression of primary repair of the duodeno-jejunal flexure transection after blunt trauma

Abstract

Small bowel injuries in general are uncommon after blunt abdominal trauma and are usually due to high-energy deceleration injuries, often in relation to motor vehicle accidents and affect fixed segments such as duodenum, duodeno-jejunal (DJ) flexure, proximal jejunum and terminal ileum. High morbidity and mortality are associated with this type of injury when the diagnosis is delayed. Untimely management of such injuries, especially transection of the DJ flexure, results in high-output entero-cutaneous fistula. In total, eight cases of DJ flexure transection with/without associated multiple injuries were reviewed retrospectively. For DJ flexure transection in all cases, the flexure was adequately mobilised, and end-to-end duodenojejunostomy performed with two-layer interrupted sutures. A large calibre nasojejunal tube was placed through the anastomotic site before completion to protect the anastomotic area from the proteolytic action of large volumes of upper gastrointestinal secretions. In case of associated injuries, appropriate procedures were done. In DJ flexure transection, a timely management by end-to-end anastomosis with administration of nasojejunal tube beyond the site of anastomosis is an alternate, simple and safe procedure in comparison to difficult procedures such as pyloric exclusion and gastrojejunostomy in patients with delayed presentation.

Jejunal transection following trivial trauma: Case report and review of literature

“…Small bowel transection though uncommon, is associated with high energy impact [1] , [2] , [3] , [4] , [5] , [6] , [7] however, transection following seemingly trivial causes like cough [7] bicycle fall [8] battered child [9] , [10] have been reported. The mechanism of injury ranges from mesenteric laceration due to compression, bowel rupture due to deceleration injury.…”

“…Severe forms of bowel injury are rare and if reported usually follow high energy impact as seen in sports related injury [1] , [2] , motor vehicle accident [3] , [4] , [5] , [6] and falls from heights. Bowel transection has been reported following supposedly trivial trauma like coughing [7] fall from a bicycle [8] , child abuse [9] , [10] , hitting an iron fence bar [11] , handle bar trauma and others [12] .…”