Delayed diagnosis of duodenal rupture

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 and diagnostic findings may not be appreciated for an extended period. The primary determinant of mortality in duodenal rupture is the presence of associated injuries, but delay in diagnosis is often a secondary factor. A retrospective case review of 8 patients with isolated duodenal rupture that was diagnosed more than 24 hours following the injury. In 5 cases, physicians did not look for the occult injury. In 3, patients did not seek medical attention. Two patients were initially treated with primary duodenal repair and drainage with poor results. All patients were eventually treated with pyloric exclusion that resulted in no deaths and no duodenal fistulas. Three patients developed abscesses after pyloric exclusion. They were drained without difficulty. Pyloric exclusion appears to offer a satisfactory option for dealing with the inflammation and contamination that result from prolonged soilage by duodenal contents.