Successful Surgical Repair of Complete Duodenal Transection Caused by Horse Kick: A Case Report.
Abstract: Horse kicks are a rare cause of injury and tend to cause severe complications such as visceral organ injury. Traumatic duodenal injuries are associated with high mortality rates. Furthermore, their reconstructive procedures vary widely and require appropriate on-the-spot judgment by the surgeon. We experienced a case of blunt abdominal trauma with a complete transection of the first portion of the duodenum caused by a horse kick without any associated lesions. A good postoperative course was achieved by trimming the pyloric part of the stomach and performing an end-to-end anastomosis between the gastric remnant and the duodenum, along with tube decompression and biliary drainage. Methods: A woman in her 50s was kicked in the right upper quadrant of her abdomen by a horse and transported to a local hospital. Computed tomography revealed pneumoperitoneum and hematoma near the duodenum, discontinuity of the duodenal wall, and a poorly contrasted area in the pancreas head. The patient underwent emergent laparotomy 6h after the accident. The first portion of the duodenum was completely lacerated. No contamination around the pancreatic head or saponification of fat tissue was observed. Because the patient's vital signs were stable and the condition of the damaged tissue was favorable, the transection was repaired with trimming of the pyloric part of the stomach and end-to-end anastomosis between the gastric remnant and the duodenum. Decompression, feeding and biliary drainage tubes were placed. The patient's postoperative course was favorable and the patient was discharged on postoperative day 20 in a stable condition. At an outpatient visit 3 months postoperatively, the patient reported no abdominal pain or stenosis symptoms. Conclusions: We experienced a rare case of a single complete duodenal transection due to a horse kick. End-to-end anastomosis with tube decompression and biliary drainage was performed because the patient's vital signs were stable, there was little contamination or contusion of the surrounding tissue, and it had not been >24h since the injury. The patient had a good course of treatment.
© 2025 The Author(s). Published by Japan Surgical Society.
Publication Date: 2025-03-11 PubMed ID: 40115220PubMed Central: PMC11925644DOI: 10.70352/scrj.cr.24-0059Google Scholar: Lookup
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Summary
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Overview
- This case report describes a successful surgical repair of a complete duodenal transection caused by a horse kick, highlighting the surgical approach and favorable patient outcome following the injury.
Introduction and Background
- Horse kicks are an uncommon trauma mechanism but can lead to severe internal injuries due to their forcefulness.
- Duodenal injuries caused by blunt trauma are particularly dangerous, associated with high mortality rates due to the risk of contamination and damage to surrounding organs.
- There is no standardized reconstructive procedure for duodenal transections; surgical management largely depends on the injury’s nature and the patient’s condition at the time of surgery.
Case Presentation
- The patient was a woman in her 50s who sustained a blunt trauma to the right upper abdomen from a horse kick.
- Initial imaging (computed tomography) revealed:
- Pneumoperitoneum (presence of air in the peritoneal cavity) indicating gastrointestinal perforation.
- Hematoma near the duodenum.
- Discontinuity of the duodenal wall confirming transection.
- A poorly contrasted area in the pancreas head, suggesting possible injury or reduced blood flow.
- The patient underwent emergency laparotomy approximately six hours after injury.
Surgical Findings and Procedure
- Intraoperative findings revealed complete transection of the first portion of the duodenum.
- No other associated injuries such as contamination around the pancreas or fat tissue saponification (indicative of pancreatic inflammation) were observed.
- Given the patient’s stable vital signs and favorable tissue condition, the surgical team decided on primary repair rather than more complex reconstructions.
- The procedure involved:
- Trimming the pyloric portion of the stomach to prepare for anastomosis.
- Performing an end-to-end anastomosis between the gastric remnant and the duodenum to restore gastrointestinal continuity.
- Placement of decompression, feeding, and biliary drainage tubes to:
- Reduce pressure and prevent leakage at the anastomosis site.
- Allow early enteral feeding.
- Drain bile to avoid bile-induced inflammation and infection.
Postoperative Course and Follow-up
- The patient’s recovery was favorable with no major complications.
- She was discharged on postoperative day 20 in stable condition.
- At a three-month outpatient follow-up, she reported no abdominal pain or symptoms of duodenal stenosis (narrowing), indicating successful surgical repair and good functional outcome.
Conclusions and Clinical Implications
- This case demonstrates:
- The importance of prompt diagnosis and timely surgical intervention in traumatic duodenal transections.
- That primary end-to-end anastomosis can be effective when performed within 24 hours of injury in stable patients without significant contamination.
- The utility of adjunctive measures such as decompression and biliary drainage tubes to support healing and reduce postoperative complications.
- The rarity of isolated complete duodenal transection from blunt trauma, such as a horse kick, highlights the need for individualized surgical judgment rather than a one-size-fits-all approach.
- The good outcome in this case suggests that less extensive surgical procedures can be employed successfully under the right conditions, possibly minimizing morbidity.
Cite This Article
APA
Asai Y, Tsunetoshi Y, Susa Y, Matsuzawa A, Miyazaki S, Itagaki Y, Yamamoto H, Kimura K, Kushiya H, Sato S, Okada N, Yamabuki T, Kato K, Kinoshita Y, Takada M, Ambo Y, Nakamura F.
(2025).
Successful Surgical Repair of Complete Duodenal Transection Caused by Horse Kick: A Case Report.
Surg Case Rep, 11(1), 24-0059.
https://doi.org/10.70352/scrj.cr.24-0059 Publication
Researcher Affiliations
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Conflict of Interest Statement
The authors declare that they have no competing interests.
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