Isolated Duodenal Rupture due to Go-Karting Accidents – Braking News

Abstract

Ann R Coll Surg Engl 2009; 91: 340-343 340Go-karting is a very popular recreational activity in the UK with easy access to race tracks throughout the country. However, due to the relatively high speeds and lack of seat belt restraint requirements, there are numerous injuries and a significant number of deaths world-wide each year.1 Small bowel injury as a result of any blunt abdominal trauma is rare (3.6%).2 Cases of isolated small bowel injury after blunt trauma are even less common (1%) with the majority (58-70%) associated with multiple injuries.2,3 Isolated duodenal injuries are extremely uncommon.We present three cases of isolated duodenal ruptures, of the D3/D4 segment, due to go-karting accidents occurring over a period of 5 months. Difficulties in clinical diagnosis of duodenal injury and the likelihood of significant complications 2,3 justifies maintaining a high index of suspicion with early investigation for patients attending with similar presentations. Case reports Case 1A healthy 29-year-old woman was brought to the accident and emergency department complaining of epigastric and right upper quadrant pain after crashing a go-kart into the side barriers of the track. Blunt abdominal trauma was sustained as the steering wheel impacted on her epigastrium during the crash. She was normotensive and had a pulse rate of 92 beats/min. There was tenderness in the right upper quadrant; however, the abdomen was soft and there was no guarding. Her white cell count (WCC) was raised at 26 × 10 9 cells/l and the haemoglobin (Hb) was normal at 12.1 g/dl. The amylase level was normal at 51 U/l. Chest and plain abdominal radiographs were unremarkable with no free air demonstrated.She was admitted and had an ultrasound scan of the abdomen the next day which demonstrated minimal perihepatic fluid (Fig. 1A) and normal solid organs. Blood investigations showed improvement and the WCC reduced to 12.1 × 10 9 cells/l. The patient remained stable with no worsening of her signs or symptoms. It was, therefore, decided to treat her conservatively and a computed tomography (CT) scan was performed to exclude any serious injury. This demonstrated a rupture in the wall of the early third part of duodenum, air pockets and a fluid collection in the retroperitoneal spaces (Fig. 1B), particularly in the retropancreatic and right anterior pararenal spaces. Some Imaging, Queen Elizabeth Hospital NHS Trust, London, UK ABSTRACT INTRODUCTION Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months. CASE REPORTS Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, ...

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“…Go-kart injuries and fatalities have been investigated by a number of researchers over the past four decades (Miller and Proctor, 1973;Youngson and Baker, 1978;Freeman et al, 1994;Stooksbury, 1996;Seow et al, 1998;Wilcoxon, 1999;Adler, 2000;Govaert et al, 2001;Stam, 2002;Grzebieta et al, 2004;Suddaby and Mowery, 2004;Ng and Chung, 2005;Conn et al, 2006;Li and Leong, 2006;Collins et al, 2007;Thomas et al, 2009;Eker et al, 2010;Grzebieta et al, 2010;Ahmad et al, 2011;Grzebieta et al, 2013). Yet little research has been carried out to increase their crashworthiness.…”