Isolated pediatric duodenal rupture after horse hoof kick.

An 8 year-old-boy was referred because of abdominal pain 24 hours after being hoof-kicked by a horse in the abdominal wall. On arrival the boy appeared ill, with nausea and vomiting and right abdominal pain. Physical examination revealed epigastric tenderness with muscle guarding in the upper abdominal wall. Because of persistent pain CT was performed and further revealed a very small amount of free subhepatic air just attached to the duodenum (Fig. 1). A hollow viscus injury was suspected. At surgery there was bile staining and dirty fluid in the paraduodenal area. A duodenal perforation (1 cm) located in the retroperitoneal segment was noticed (Fig. 2). A primary surgical repair of the duodenal rupture was made. The patient’s postoperative course was uneventful and was discharged at home seven days later.