Samir Ranjan nayak¹,Dilip kumar soren²,Ganni bhaskara rao³,M udaya kiran 4 ¹.Associate professor department surgery,GSL medical collegeRajahmundry AP india ². associate professor department surgery,GSL medical collegeRajahmundry AP india 3 associate professor department surgery,GSL medical collegeRajahmundry AP india 4.resident , department surgery,GSL medical collegeRajahmundry AP india Abstract: Isolated duodenal injury in abdominal trauma is extremely rare. A diagnosis of isolated duodenal

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... jury may be very difficult to make out in abdominal trauma, even with the availability of Ultrasound and CT scan. Delays in diagnosis due to late clinical presentation, and intra operative dilemmas due to retroperitoneal location of the duodenum, its proximity to important abdominal structures, lead to difficulties in management and considerably increase morbidity and mortality in these patients We report a case of fall from height with a puncture wound over the right loin presented after 20 hours with pain abdomen.USG abdomen ,CT abdomen ,DPL show minimal hemoperitoneum which prompted us to doDiagnostic laparoscope .except a small mesenteric injury solid and hollow viscera were found normal, 4 days later patient had greenish discharge from the puncture wound back evaluated and diagnosed as duodenocutaneous fistula by contrast and upper GI scope .patient was treated with simple gastrojejejunostomy and keeping ryle's tube inafferent loop for decompression of duodenum and feeding jejunostomyfor nutrition. Fistula healed and patient was discharged on 11 th postop day A small punctured wound over the back in a trauma abdomen presenting as to duodeno-cutaneous fistula after 96 hours is an unusual presentation.