A clinical analysis of 25 cases of retroperitoneal duodenal Perforation due to trauma, treated at capital Armed Forces General Hospital during past 5 years from January 1971 to December 1975 was done.
The following results were obtained:
1. All was male and the majority of cases were 3rd decades.
2. The causes of injuries were traffic accident: 16 cases (64%), blow to abdomen: 7 cases (28%), fall from height: 2 cases (8%)
3. In the majority of cases site of retroperitoneal duodenal perforation was 2nd portion of duodenum 16 cases (64%)
4. The cases operated within 8hrs were 16 cases(64%)
5. Associated injuries included, in order of frequency, pancreas, 8 cases (32%), liver 77, cases (28%), small bowel 6 cases (24%), kidney, 2 cases (8%), spleen 2 cases (8%).
6. The clinical symptoms, and signs included abdominal pain (92%), abdominal tenderness (84%), rebound tenderness (86%), abdominal rigidity(72%), decreased peristalsis (72%), back pain (16%), flank pain (12%), hematuria (8%).
7. The observation of retroperitoneal free gas shadow in the roentgenologic examination was valuable for diagnosis of retroperitoneal duodenal perforation in 2 cases (8%) and abdominal paracentesis revealed positive, in 5 cases (20%).
8. The cases in which retroperfoneal duodenal perforation was not noticed in the first explaratory laparotomy were 3 cases (12%)
9. Simple closure and retroperitoneal drainage was performed in the 8 cases (32%), simple closure, retroperitoneal drainage, and jejunostomy 14 cases (56%),´retroperitoneal drainage, jejunostomy and Roux-en-Y duodenjejunostomy: I cases (4%) paucreaticoduodenectomy: 2 cases (8 % ).
10. Complications included, in order of frequency duodenal fistula (32%), wound infection (28%), intestinal obstruction (12 %), pancreatic fistula (8%) bleeding (8%), pancreatitis(8%).
11) Mortality rate was 245% and the causes of death were sepsis due to duodenal fistula: 3 cases
12.) Pancreatitis 1 case (4%), intestinal obstruction: 1 case (4%) bleeding: 1 case (41%).
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