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Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

2014, Number 3

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Rev Esp Med Quir 2014; 19 (3)

Surgical management of a late duodenal perforation associated with abdominal sepsis secondary to the incidental ingestion of a toothpick

Zavala-Retes B, Ortiz-Barrón S, Guzmán-Valdivia-Gómez G, Guerrero-Aguirre J, Salazar LCR

Language: Spanish
References: 18
Page: 363-370
PDF size: 891.05 Kb.


ABSTRACT

Most accidentally swallowed objects that manage a successful passage through the esophagus usually sail through the rest of the digestive tract without complications. However, when they cause duodenal lesions, they are among the most lethal and morbid intestinal lesions, not to mention the complex medical and surgical therapy required due to its anatomical location and physiology. Within the surgical techniques available, there are those simple procedures such as primary repairs in one or two layers; and complex procedures, that include intestinal resections and anastomosis as adjuvant procedures to prevent passage of the intestinal contents through the injured area and anastomotic lines. In this report, we describe the case of a 29-year-oldmale patient with cerebral palsy who presented a perforating injury between the second and third portion of the duodenum 7 days before receiving medical attention, secondary to accidental ingestion of a wooden toothpick. The patient underwent laparotomy, abdominal wash, primary repair in 2 layers of the duodenal perforation, lateral duodenostomy, pyloric exclusion, and a Braun’s Omega gastroyeyunostomy procedure to ensure proper wound healing and decrease the risk of reoperation. Five weeks after the surgical procedure, the patient fully recovered from surgery without associated complications and was discharged in good general conditions, with normal gastrointestinal function, without probes or drains and a wound completely healed. A computer-based search of the literature to examine duodenal injuries caused by ingested toothpicks found only three reports.


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