Kim DH, Choi H, Kim KB, Yun HY, Han JH. Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report. World J Clin Cases 2019; 7(20): 3271-3275 [PMID: 31667178 DOI: 10.12998/wjcc.v7.i20.3271]
Corresponding Author of This Article
Joung-Ho Han, MD, Professor, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju-si 28644, South Korea. joungho@cbnu.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2019; 7(20): 3271-3275 Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3271
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
Dae Hoon Kim, Hanlim Choi, Hyo Yung Yun, Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
Ki Bae Kim, Joung-Ho Han, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, South Korea
Author contributions: Kim DH wrote the manuscript; Han JH revised the manuscript; Choi H did the case analysis; Kim KB and Yun HY did the data collection. All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient’s parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Joung-Ho Han, MD, Professor, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju-si 28644, South Korea. joungho@cbnu.ac.kr
Telephone: +82-43-2696802 Fax: +82-43-2733252
Received: June 28, 2019 Peer-review started: June 29, 2019 First decision: July 31, 2019 Revised: September 18, 2019 Accepted: October 5, 2019 Article in press: October 5, 2019 Published online: October 26, 2019
Abstract
BACKGROUND
A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy, but is not typically an indication for endoscopic treatment.
CASE SUMMARY
A 27-year-old man visited the emergency department with a self-inflicted abdominal stab wound. Injuries to the colon and ileum were detected, but an injury to the second portion of the duodenum was missed. On the day following admission to our institution, the patient became hemodynamically unstable with massive hematochezia, although there was no evidence of bleeding in the Levin tube or Jackson-Pratt drain. We thus performed an upper gastrointestinal endoscopy and discovered a missed duodenal injury that was actively bleeding. An endoscopic band ligation was performed for hemostasis and closure of the perforation. The patient was subsequently discharged without any complications.
CONCLUSION
A penetrating injury of the duodenum can be overlooked, so careful abdominal exploration is very important. If a missed duodenal injury is suspected, a cautious endoscopic approach may be helpful.
Core tip: Following a penetrating abdominal injury, it is very important for surgeons to find all associated lesions. Insufficient abdominal exploration can result in a missed injury, occasionally leading to the need for reoperation and possibly a fatal outcome. We successfully treated a rare case of perforation and bleeding in the third portion of the duodenum, which was not found by upper-abdominal exploration during the initial surgery. If a missed hollow viscus injury, particularly in the duodenum, remains despite such efforts, an endoscopic approach may be helpful in some cases.
