Challenges in the Diagnostics and Treatment of Duodenum Injuries in Children

Abstract

Objective: To study the clinical presentations and diagnosis of injuries to the duodenum in children. Methods: The study analyses the diagnosis and treatment of duodenal injuries in 14 children admitted to pediatric surgery departments at the Bashkir State Medical University, Ufa, Russia and Saint-Petersburg State Pediatric Medical University, Russia, between 2000 and 2020. The clinical presentations of duodenal injuries, diagnostic challenges and preoperative and intraoperative errors were evaluated. Results: High diagnostic error rates were observed since practitioners have a knowledge gap regarding the clinical presentation and surgical treatment principles of duodenal trauma among affected children. The authors believe that the presence of one of the symptoms (retroperitoneal hematoma, emphysema, yellowish green staining of the retroperitoneum and tissues is an indication for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Conclusion: Damage to the duodenum in children presents considerable difficulties in diagnosis and treatment. In this regard, imaging studies should be employed for diagnosis. Diagnostic laparoscopy is considered the gold standard for preoperative clinical evaluation. Retroperitoneal hematoma and/or emphysema, and yellow-green staining of the retroperitoneum and tissues, are indications for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Keywords: Duodenum, trauma, diagnosis, surgical treatment.