A Case of Duodenal Injury with Pancreatic and Superior Mesenteric Venous Injury Successfully Treated by Temporal Pyloric Occlusion Technique with Damage Control Celiotomy

Atsushi Nagashima, Hiroshi Yoshii, Mitsuhide Kitano, Masakazu Doi, Shinobu Hayashi and Tomohisa Egawa

Department of Surgery, Saiseikai Kanagawaken Hospital

We report a case of duodenal injury with pancreatic and superior mesenteric venous injury following blunt trauma treated surgically by temporal pyloric occlusion. A 40-year-old man struck on the abdomen in a traffic accident was found in post computed tomography (CT) to have extravasation from the superior mesenteric vein (SMV) and intraabdominal hemorrhage. Laparotomy showed massive hemorrhage and injuries to the SMV, third portion of duodenum, pancreas head and colon were found. SMV hemostasis was conducted, then coagulopathy was revealed, therefore rapid closure of abdominal wall was immediately performed by gauze packing for the prevention of contamination. After the coagulopathy was improved at ICU, and a second laparotomy was done. The hemorrhage was almost controlled with gauze packing. The injured duodenum was treated by temporal pyloric occlusion without gastrojejunostomy. The pylorus was reopened with gastroendoscopy on postoperative day (POD) 17. The patient was discharged on POD 42 with an uneventful recovery. We found temporal pyloric occlusion is effective in treating severe duodenal injury.

Key words
duodenal injury, damage control celiotomy, pyloric exclusion

Reprint requests
Atsushi Nagashima Department of surgery, Saiseikai kanagawaken hospital
6-6 Tomiya-cho, Kanagawa-ku, Yokohama, 221-0861 JAPAN

Accepted
November 26, 2003

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