A 23-year-old man, with no history of medical or surgical disease arrive to our hospital with the presence of epigastric abdominal pain after a car accident. On examination, he was afebrile with an epigastric localized visceral pain and mild tenderness in the same area. His laboratory studies showed normal level of haemoglobin, white blood cell count of 14,400/mm3 with 86% neutrophils and a C-reactive protein of 11.6 mg/ dL.
The patient was then submitted to a CT scan (Figure 1) that showed a large, irregularly shaped deep ulceration on the second duodenum (Figure 2). What is the most likely diagnosis and hoe should it be managed?
Figure 1. Duodenal Trauma – 1
Figure 2. Duodenal Trauma – 2
The patient was then submitted to ad urgent surgery and treated with a complete gastric exclusion performed with Billroth II gastro-enteric bypass, suture of duodenum and bilious exclusion with positioning of Kehr drainage (Figure 3).
Figure 3. Duodenal Trauma - 3
The patient had uneventful postoperative course and was discharged at twelve postoperative day. I was then submitted to a Kehr removal after 1 month later.
Fabio Pulighe and Gian Pietro Gusai contributed to the writing of the text.
Editorial Information
Editor-in-Chief
Article Type
Case Report
Publication history
Received date: February 01, 2020
Accepted date: February 11, 2020
Published date: February 14, 2020
Copyright
©2020 Pulighe F. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation
Pulighe F, Gusai1 GP, Requejo AS. (2020) Atypical epigastric pain: Case Report. Case Rep Imag Surg 3: doi: 10.15761/CRIS.1000129
Corresponding author
Fabio Pulighe
Ospedale San Francesco, Nuoro, Italy.
E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk