case_images: PMC11409396_01
case_images: Computed tomography abdomen pelvis (CTAP) axial view of abdomen with intraperitoneal free air in relation to perforation of third duodenal portion.
case_images: tsaco-9-1-g001.jpg
case_images: PMC11409396_01_tsaco-9-1-g001.jpg
case_images: F1
case_images: Bowel injury is suspected (figure 1).'
case_images: PMC11409396_02
case_images: PMC11409396_03
case_images: Methylene blue pooling in the retroperitoneum at the level of the aortic bifurcation and iliac vessels.
case_images: tsaco-9-1-g002.jpg
case_images: PMC11409396_03_tsaco-9-1-g002.jpg
case_images: F2
case_images: Since the injury was still unable to be visualized, methylene blue was given through the NGT, which pooled at the previously identified area of inflammation (figure 2).
case_images: Perforation in the distal posterior third portion of the duodenum less than 50% of the circumference of the bowel.
case_images: tsaco-9-1-g003.jpg
case_images: PMC11409396_03_tsaco-9-1-g003.jpg
case_images: F3
case_images: This guided us to dissect the posterior aspect of the third portion of the duodenum, which revealed a duodenal perforation that was less than 50% circumference of the bowel and a preserved inferior mesenteric vein (figure 3).