TREATMENT OF A DUODENAL FISTULA DEVELOPING FOLLOWING A FIREARM INJURY USING AN ENDOSCOPIC STENT: AN ALTERNATIVE APPROACH TO SURGERY
43. NATIONAL CONGRESS of the TURKISH ASSOCIATION of PEDIATRIC SURGEONS JOINT CONGRESS with the EGYPTIAN PEDIATRIC SURGERY ASSOCIATION, İstanbul, Türkiye, 21 - 24 Ekim 2026, cilt.43, ss.4-5, (Özet Bildiri)
- Yayın Türü: Bildiri / Özet Bildiri
- Cilt numarası: 43
- Basıldığı Şehir: İstanbul
- Basıldığı Ülke: Türkiye
- Sayfa Sayıları: ss.4-5
- Kocaeli Üniversitesi Adresli: Evet
Özet
Introduction Duodenal injuries, although infrequent, are highly morbid complications associated with penetrating abdominal trauma. If not identified during the initial surgical exploration, these injuries can result in severe complications, including delayed perforation, intra-abdominal collections, duodenal fistula formation. Recently, endoscopic procedures have emerged as significant minimally invasive treatment options, offering alternatives to repeated surgical interventions in appropriately selected patients. Case 17year old female patient underwent emergency surgery for a firearm injury. During the initial exploration, primary repair was performed for the colon injuries, with no apparent perforations detected in the duodenum or pancreas. However, owing to persistent signs of infection and pathological material from the drainage in the postoperative period, a contrast-enhanced abdominal computed tomography scan was performed. The scan revealed multiple intra-abdominal collections extending to the right paracolic space and the area adjacent to the right psoas. On the 14th postoperative day, upper gastrointestinal endoscopy revealed suture material protruding into the lumen and purulent drainage from the second portion of the duodenum, indicative of a duodenal fistula. Consequently, endoscopic treatment was chosen over repeat surgery, and a covered duodenal stent was placed on the 19th postoperative day after the first surgery. Following this intervention, the patient exhibited significant improvement in clinical and laboratory findings and was discharged without complications on the 35th postoperative day after the second surgery. The stent was removed endoscopically after one month. Discussion and Conclusion Delayed diagnosis of duodenal injuries can increase morbidity and mortality risks. Repeat surgical interventions often present substantial technical challenges owing to anatomical complexities and an increased risk of complications. In selected patients, endoscopic stent placement offers an effective, safe, minimally invasive treatment for managing duodenal fistulas. This case illustrates that endoscopic stent placement can serve as an alternative approach, potentially reducing the need for repeat surgery in cases of duodenal fistulas. Keywords: Duodenal fistula, firearm injury, endoscopic stent, pediatric trauma, duodenal perforation