2026年 · 第41卷第05期

About the author: Mr. Huang Zhimin (son of the late famous surgeon Professor Huang Ting) graduated from the Medical Department of Beijing Medical College in 1983. He worked in Beijing Chest Hospital and was engaged in the clinical work of thoracic surgery. In 1986, he went to the United States to further study and obtained a master's degree in computer science. Since then, he has been engaged in financial system analysis in Chicago, USA for a long time. He was a senior system analyst of Chicago Board Options Exchange and JPMorgan Chase, and retired in 2025.

Case 1: A 59-year-old female underwent duodenal polypectomy in an external hospital 1d before admission. After the operation, she developed abdominal pain and distension, accompanied by fever, and accelerated heart rate and breathing. After conservative treatment, the discomfort symptoms were not significantly relieved, and the symptoms of the patient progressively aggravated. In the emergency department, CT of the upper abdomen showed gas and exudation around the duodenum, and duodenal perforation was considered, so we were transferred to the emergency department of our hospital for surgical treatment. Admission physical examination: the abdomen is swollen, the abdominal muscles are slightly tense, the whole abdomen has tenderness, no rebound pain, no abdominal mass, and the intestinal sound is weak, 2 times/min. Total abdominal CT scan: nodular dense shadow at the junction of descending and horizontal duodenum, adjacent intestinal wall thickening with peripheral exudation and scattered gas accumulation, considering the possibility of perforation; Localized peritonitis in the right middle and upper abdomen (Figure 1). The test results of the patient showed that white blood cells, procalcitonin and C-reactive protein were elevated. Consider "duodenal injury" in combination with the patient's medical history, signs and examination. Surgical exploration showed obvious edema and adhesion in the right upper abdomen, a small amount of purulent coating attached to the right liver diaphragm, and a small amount of gray-green pus in the paracolonic sulcus. Fully free the hepatic area of the colon and the right transverse colon, expose the C-ring of the duodenum and the front of the pancreatic head, and free the lateral side of the duodenum. A rupture of about 2.5 cm in diameter was seen in the lateral wall at the junction of the descending and horizontal part of the duodenum, and several metal clips were seen inside. The metal clips were removed and the wound bleeding was stopped. The jejunal nutrition tube and double-set gastrostomy were placed. After the jejunal nutrition tube and gastrostomy tube crossed the horizontal section of the duodenum and entered the jejunum under direct vision, the barb line closed the duodenal rupture. After flushing the abdominal cavity with a large amount of normal saline, two double sets of abdominal drainage tubes were placed crosswise on the outside and below the duodenal rupture, and the operation was ended after checking for no active bleeding and leakage (Figure 2). The patients were treated with acid inhibition and enzyme inhibition, anti-infection and nutritional support. Upper abdominal CT examination on the 3rd and 13th days after operation showed that the free gas in the abdominal cavity gradually decreased and the symptoms of peritonitis were alleviated. On the 14th postoperative day, the patient gradually resumed oral feeding, and the jejunal nutrition tube was removed and changed to a full fluid diet. On the 15th postoperative day, the upper gastrointestinal tract was re-examined, and no contrast spillage at the junction of the descending and horizontal duodenum was found. On the 17th postoperative day, the paraduodenal drainage was removed. On the 30th postoperative day, the patient was discharged with a descending duodenal drainage tube and gastrostomy tube. The duodenal drainage tube had no fluid drainage, and the gastrostomy tube had been clamped for 2 days at the time of discharge. The descending duodenal drainage tube was clamped for 1 week and then returned to hospital for extubation, and the gastrostomy tube was clamped for 2 weeks and then returned to hospital for extubation.