DELAYED DIAGNOSIS OF DUODENAL RUPTURE

BACKGROUND: Although duodenal rupture is usually diagnosed during the course of surgery for other injuries, a small portion of such injuries occur in isolation. In such cases, the significance of the clinical a nd dignostic findings may not be appreciated for an extended period. T he primary determinant of mortality in duodenal rupture is the presenc e of associated injuries, but delay in diagnosis is often a secondary factor. METHODS: A retrospective case review of 8 patients with isolat ed duodenal rupture that was diagnosed more than 24 hours following th e injury. RESULTS: In 5 cases, physicians did not look for the occult injury. In 3, patients did not seek medical attention. Two patients we re initially treated with primary duodenal repair and drainage with po or results. Ah patients were eventually treated with pyloric exclusion that resulted in no deaths and no duodenal fistulas. Three patients d eveloped abscesses after pyloric exclusion. They were drained without difficulty. CONCLUSION: Pyloric exclusion appears to offer a satisfact ory option for dealing with the inflammation and contamination that re sult from prolonged soilage by duodenal contents.