More well-designed studies with a large number of cases are still necessary to determine a proper www.selleckchem.com/products/kpt-330.html protocol for this tumor. Fig. 2 Giant cell tumor of tendon sheath of thumb, intraoperative aspect.The difficulty to diagnose in time, along with high morbidity and mortality associated with these injuries, make duodenal injuries an ongoing challenge for trauma surgeons. Trauma of the duodenum is not common due to its deep, central and retroperitoneal location. Duodenal injuries may follow penetrating or blunt abdomen trauma. Blunt duodenal injury occurred with a low incidence (about 0.2%) and was most often caused by motor vehicle accidents (1). However, blunt trauma is more common and usually results from car or bicycle accidents, child abuse, falls, and playground accidents (2).

Clinical findings following isolated, blunt duodenal trauma depend on the severity of the injury and the examination time. Such findings are, in general, often discrete. Initial symptoms and physical findings that included nausea, vomiting, abdominal pain, and tenderness were common but nonspecific in differentiating the type of duodenal injury (3). The diagnostic difficulty is due to the localization of duodenum. Therefore, a duodenal injury has to be considered in any patient presenting with a history of abdominal trauma. Diagnostics in case of blunt abdominal trauma should include blood sampling, plain abdominal X-rays and abdominal ultrasound scan (USS). Laboratory findings can give rise to the level of leukocyte and pancreatic enzymes.

The presence of free air in the plain abdominal X-rays and free liquid in the FAST are important data in the case of abdominal trauma. USS can assess duodenal integrity and associated injury, and is also useful in following hematoma resolution (4). Suspicion of duodenal injury necessitates an enhanced abdominal computed tomography (CT); it can exclude or confirm the presence of air or fluid in the retropreritoneal space. Diagnostic peritoneal lavage is unreliable in finding duodenal injury. It may be positive for blood, bile or bowel contents but, if negative, does not exclude duodenal injuries (5). The treatment of duodenal trauma should be based on the classification of duodenal trauma, according to American Association Trauma Surgery and the factors determining the gravity of these injuries, which include size and location of the injury, the time interval between the injury and intervention, and injury of the hepatic bile duct.

Complications after duodenal injuries are frequent (20% overall), and are significantly increased when the diagnosis is delayed (1). An operative delay of more than 24 h is reported to increase the complication rate from 29% to 43%, and mortality from 11% to 40% (6). Case report A 5-year-old boy, with no medical history, was involved Brefeldin_A in a motor vehicle crash (MVC) and initially treated in a rural hospital in Albania. The patient complained about gradually worsening upper abdomen pain.