Successful Surgical Repair of Complete Duodenal Transection Caused by Horse Kick: A Case Report.

Abstract

Introduction: Horse kicks are a rare cause of injury and tend to cause severe complications such as visceral organ injury. Traumatic duodenal injuries are associated with high mortality rates. Furthermore, their reconstructive procedures vary widely and require appropriate on-the-spot judgment by the surgeon. We experienced a case of blunt abdominal trauma with a complete transection of the first portion of the duodenum caused by a horse kick without any associated lesions. A good postoperative course was achieved by trimming the pyloric part of the stomach and performing an end-to-end anastomosis between the gastric remnant and the duodenum, along with tube decompression and biliary drainage.

Case presentation: A woman in her 50s was kicked in the right upper quadrant of her abdomen by a horse and transported to a local hospital. Computed tomography revealed pneumoperitoneum and hematoma near the duodenum, discontinuity of the duodenal wall, and a poorly contrasted area in the pancreas head. The patient underwent emergent laparotomy 6h after the accident. The first portion of the duodenum was completely lacerated. No contamination around the pancreatic head or saponification of fat tissue was observed. Because the patient's vital signs were stable and the condition of the damaged tissue was favorable, the transection was repaired with trimming of the pyloric part of the stomach and end-to-end anastomosis between the gastric remnant and the duodenum. Decompression, feeding and biliary drainage tubes were placed. The patient's postoperative course was favorable and the patient was discharged on postoperative day 20 in a stable condition. At an outpatient visit 3 months postoperatively, the patient reported no abdominal pain or stenosis symptoms.

Conclusions: We experienced a rare case of a single complete duodenal transection due to a horse kick. End-to-end anastomosis with tube decompression and biliary drainage was performed because the patient's vital signs were stable, there was little contamination or contusion of the surrounding tissue, and it had not been >24h since the injury. The patient had a good course of treatment.