Operative Approach in Traumatic Injuries of the Duodenum

• Published in: Acta chirurgica belgica 2006, Vol.106 (4), p.405-408
• Main Authors: Bozkurt, B., Özdemir, B.A., Kocer, B., Unal, B., Dolapci, M., Cengiz, O.
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - surgery; Adolescent; Adult; Aged; Biological and medical sciences; Cause of Death; duodenal injury; Duodenostomy - methods; Duodenum - injuries; Duodenum - surgery; Female; General aspects; Hematoma - surgery; Humans; Injuries of the abdomen. Foreign bodies of the digestive system; Intestinal Perforation - surgery; Lacerations - surgery; Laparotomy; Male; Medical sciences; Middle Aged; Retrospective Studies; Trauma; Traumas. Diseases due to physical agents; Wounds, Nonpenetrating - surgery; Wounds, Penetrating - surgery
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2006.11679916

Background: The management of duodenal traumas remains controversial. The experience of Ankara Numune Training and Research Hospital Emergency Surgery Department with duodena! injuries during a 10-year period was analyzed to identify trends in operative management and sources of duodenum-related morbidity and mortality. Methods and Results: Between 1994 and 2003, 1799 patients with blunt abdominal trauma were operated on and the incidence of duodenal trauma was 2.8% (50 patients). The injuries were penetrating in 31 (62%) patients and blunt in 19 (38%). Primary repair (PR) of injury was performed in 24 (48%) patients, primary repair and tube duodenostomy (PRTd) in 8 (16%) patients, complex repair (CR) in 11 (22%) patients, and exploration only without a duodenal procedure in 5 (10%) patients. Two of the patients died during laparotomy. The mortality rate was 12% and the incidence of duodenum-related morbidity was 12%. The overall morbidity rate was 40% (20 patients). The most commonly injured portion of the duodenum was DII (58%), and the most frequent cause of duodenum-related and overall morbidity in our series was Grade III duodenal injury. Conclusion: Our experience suggests that the use of primary repair in grade III injury may be associated with higher duodenum-related morbidity. Our recommendation is to use complex repair for grade III duodenal injuries.