Retrospective analysis of duodenal injuries: A comprehensive overview

Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies. ARTICLE HISTORY

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“…Isolated duodenal injuries are rare. Duodenal injuries often occur together with other organ injuries and damages to large vessels [34].…”

Section: Traumamentioning

confidence: 99%

Diagnosis and management of duodenal perforations: a narrative review

Ansari

Torén

Lindberg

et al. 2019

Scandinavian Journal of Gastroenterology

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“…Assensio et al 2 describe that liver injury (16.9%) is most commonly associated to duodenal injury, followed by pancreatic injury (11.6%), small intestine (11.5%), and colon (11.3%). According to Pandey et al, 11 the liver is the organ most affected, followed by colon (43%) and pancreas (14%). In this study, the associated injuries observed were most prevalent in the liver and small intestine with incidence of both of 45.45%.…”

Section: Discussionmentioning

confidence: 97%

“…The treatment of duodenal lesions varies according to the severity of each individual case, and can involve anything from primary closure to a Whipple procedure. 11,12 However, according to Ordonez et al 6 , in more severe cases, mainly those associated with multiple organ injuries & hemodynamic instability (accounting for 25% of deaths -hypovolemic shock) it is recommended to perform damage control surgery briefly in order to put the patient in a better position for definitive treatment. Primary duodenal repair is the main intervention in this study (90.9%), as described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In 90.9% of cases analyzed in this study, this time period was up to 6 hours. Pandey et al 11 demonstrate that most of the patients analyzed were received at the service within 6 hours after penetrating trauma duodenum and between 12 and 24 hours after blunt trauma. All patients were addressed surgically between 24 and 48 hours after admission to the service.…”

Section: Discussionmentioning

confidence: 99%

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Alcoholic Beverage and Traffic Accidents: Impact of the Drunk-Driving Law in Severity and Mortality of Victims

Nogueira¹,

Domingues²,

Bonfim³

2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Rationale: Duodenal injuries are rare and most common due to penetrating abdominal trauma, especially gunshot wounds, with greatest prevalence among young men. Achieving simpler and more effective surgical procedures also contributes to the reduction of mortality and morbidity rates.Objective: Review cases of penetrating and blunt duodenal trauma, the complexity of the injuries, incidence, management as well as morbidity and mortality. Materials and methods:At Grajaú General Hospital, between January 2010 and May 2014, a retrospective analysis of 1,039 patients' medical records who had undergone emergency exploratory laparotomies was done. From these cases, 298 were caused by blunt and penetrating abdominal traumas, and 11 suffered duodenal traumas.Results: It was observed that there was a predominance of young adults (mean age 26.48 years) and all patients were males (100%), of which one injury was from blunt abdominal trauma, three from stab wounds, and seven caused by firearm. Most of the duodenal injuries were classified as grade II injuries and most commonly involved the fourth portion of the duodenum. We emphasize the association with injuries to other organs, especially the liver and the small intestine. In the cases we analyzed, we highlight the importance of time between entry of service and surgery in all patients being less than 6 hours. The most common surgery performed to repair these injuries was duodenorrhaphy (90.9%). In this series, there were four deaths. Postoperative complications included duodenal fistulae with spontaneous resolution.Conclusion: Duodenal injuries are rare, and are most commonly due to penetrating abdominal trauma, especially gunshot wounds, with the greatest prevalence among young men. There is a need for early diagnosis and rapid surgical intervention, shortened and effective surgical procedures, due to the morbidity/mortality and high complexity of these injuries. This emphasizes the importance of early intervention in the short time before surgical procedure takes place.

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“…El hígado fue el ó rgano má s comú nmente dañ ado, con un total de 600 lesiones ocurridas con una frecuencia del 17%. Otros ó rganos incluyeron el colon con 462 (13%), el pá ncreas con 408 (12%), el intestino delgado con 395 (11%), el estó mago con 323 (9%) y las lesiones vasculares (arterial y venoso) con 536 (15%) 3,4,6-13,17,19-22,24-26 . Localizació n anató mica de la lesió n Para identificar la localizació n anató mica de mayor frecuencia se revisaron 15 series publicadas 2,6,7,[10][11][12][13][14][15]19,21,22,[24][25][26] 6 , 1975 (22) 17 (1%) 5 (0,3%) Lucas y Ledgerwood 8 , 1975 (36) 0 36 (2%) Matolo et al 9 , 1975 (32) 19 (1,1%) 13 (0,8%) Kelly et al 2 , 1978 (34) 28 (1,6%) 6 (0,3%) Stone y Fabian 10 , 1979 (321) 294 (16,7%) 27 (1,5%) Flint et al 11 , 1979 (75) 56 (3,2%) 19 (1,1%) Snyder et al 12 , 1980 (228) 180 (10,2%) 48 (2,7%) Levinson et al 50 , 1982 (93) 74 (4,2%) 19 (1,1%) Adkins y Keyser 13 , 1984 (56) 39 (2,2%) 17 (1%) Fabian et al 14 , 1984 (10) 0 10 (0,6%) Ivatury et al 15 , 1985 (100) 100 (5,7%) 0 Bostman et al 16 , 1989 (22) 16 (1%) 6 (0,3%) Cogbill et al 17 , 1990 (164) 102 (5,8%) 62 (3,5%) Cuddington et al 18 , 1990 (42) 16 (1%) 26 (1,5%) Timaran et al 19 , 1999 (152) 152 (8,6%) 0 Jen-Feng Fang et al 20 , 1999 (18) 0 18 (1%) Jansen et al 21 , 2002 (30) 27 (1,5%) 3 (0,2%) Seamon et al 22 , 2007 (29) 29 (1,6%) 0 Rathore et al 23 , 2007 (23) 16 (1%) 7 (0,4%) Pereira et al 24 , 2008 (8) 5 (0,3%) 3 (0,2%) Girgin et al 25 , 2009 (67) 59 (3,4%) 8 (0,5%) Sanjai et al 26 , 2011 (14) 8 (0,5%) 6 (0,3%) Total (1.760) 1400 (80%) 360 (20%) c i r e s p . 2 0 1 4 ; x x ( x x ) : x x x -x x x analiza...…”

Section: Lesiones Asociadasunclassified