A case of NBCA (n-butylcyanoacrylate: Histoacryl®) injection therapy was successful to a duodenal injury diagnosed after about three weeks

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 25; no. 10; pp. 766 - 772
• Main Authors: Nagashima, Futoshi, Kobayashi, Makoto, Oka, Kazuyuki, Bansyoutani, Yuki, Matsui, Daisaku, Maeyama, Hiroki, Nakajima, Mari
• Format: Journal Article
• Language: English; Japanese
• Published: Japanese Association for Acute Medicine 15.10.2014
• Subjects: duodenoscopy; minimally invasive treatment; retroperitoneal abscess
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.25.766

Delayed diagnosis of traumatic duodenal injury raises the mortality rate and surgical treatment is usually performed. Here we report a case of duodenal injury that led to the diagnosis about three weeks after injury, and minimally invasive treatment, Histoacryl® injection therapy, rather than surgical intervention was successful. A 56-year-old woman was injured while driving her car. After recognizing hemoperitoneum, free air, and liver injury etc. on computed tomography (CT), we performed an emergency laparotomy. The postoperative course was uneventful. But on the 23rd day, we recognized an increase of the inflammatory response.It showed a right retroperitoneal abscess due to duodenal injury on the CT and an opening of the fistula at the duodenum 3rd portion by duodenoscopy. We injected the Histoacryl® into the fistula from the abscess cavity and into the inside of the duodenum. Then, closure of the fistula in the duodenoscopy was seen. She was discharged without any problems. In conclusion , the Histoacryl® injection therapy is limited, but an easy and minimally invasive method. It can be considered as one of the treatments for duodenal injury.