Clinical Suspicion in Delayed Isolated Duodenal Perforation in a Child: A Case Report

After blunt abdominal trauma, severe injuries to the duodenum are rare but can be serious. As the duodenum lies retroperitoneally, perforation may not cause noticeable symptoms, leading to delayed diagnosis. Isolated duodenal perforation (IDP) is difficult to diagnose due to nonspecific symptoms. Early detection with a computed tomography (CT) scan is fundamental for saving lives.  In prior studies, approximately 100 cases of IDP in children have been reported. The present study highlights the high index of clinical suspicion, along with the crucial role of the CT scan in detecting this injury. A 7-year-old boy arrived with worsening right abdominal pain, fever, and vomiting 9 days after a road traffic accident. Upon admission, leukocytosis (28.44 ×10³/µL) and contrast-enhanced abdominal CT  findings revealed retroperitoneal free air and suspected bowel perforation. Exploratory laparotomy confirmed a 3 cm duodenal perforation, repaired by two-layer duodenorrhaphy and omental patch. Postoperative recovery was successful with multidisciplinary care. Therefore, isolated duodenal perforation warrants a high degree of suspicion in pediatric patients with blunt trauma. Early contrast-enhanced abdominal  CT and prompt surgical intervention are crucial to reduce morbidity and mortality.