Traumatic bowel perforation at the duodenojejunal flexure

Case contributed by Dr Robert G

Presentation

Left upper abdominal pain after she fell off her bicycle and was hit in the abdomen by the handlebar

Patient Data

Age: 25 years
Gender: Female

There is retroperitoneal as well as intraperitoneal hematoma around the duodenojejunal flexure at the ligament of Treitz. Furthermore, bubbles of extraintestinal gas can be appreciated near the duodenojejunal flexure as well as in the mesenterium. The pancreas, which was the surgeons' primary concern, shows no direct sign of trauma.

Intraoperative photographs of the perforation at the duodenojejunal flexure pre- and post repair.

Case Discussion

This is a case of traumatic bowel perforation at the duodenojejunal flexure. The localization of the hematoma in combination with the finding of both retroperitoneal and intraperitoneal extraluminal gas allowed us to pinpoint the location of the perforation, which was confirmed intraoperatively. The duodenojejunal flexure is a common location for traumatic bowel perforation due to its relative fixation by the ligament of Treitz, making it susceptible to injury by shearing forces.

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