Trauma de duodeno: análise de fatores relacionados à morbimortalidade

Fraga, Gustavo Pereira; Biazotto, Guilherme; Villaça, Marcelo Pinheiro; Andreollo, Nelson Adami; Mantovani, Mário

doi:10.1590/s0100-69912008000200006

Cited by 9 publications

(25 citation statements)

References 28 publications

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“…Among the injured duodenal portions analyzed, the extent of duodenal damage was studied, showing a majority of grade II injuries (63.63%). These results are consistent with the literature and with findings by Fraga et al, 1 which note that the frequencies of grade II and III lesions are the most common, representing 90.9% of the injuries. Typically, these lesions have been associated with injuries to other organs, and as described in the literature, it is rare to find the presence of an isolated injury.…”

Section: Discussionsupporting

confidence: 93%

“…1 Being predominantly a retroperitoneal organ, this type of injury is often associated with high-impact trauma and thus concomitant injuries to other organs, such as liver, spleen, and pancreas are common. In addition to the factors mentioned above, especially the location and early diagnosis of duodenal injuries remain a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the factors mentioned above, especially the location and early diagnosis of duodenal injuries remain a challenge. 1,2 Statistically, duodenal injury occurs in about 3 to 5% of abdominal trauma, and penetrating injuries are responsible for most cases. [3][4][5][6][7] The morbidity and mortality of this type of injury is directly related to diagnostic delay and associated injuries.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7] The morbidity and mortality of this type of injury is directly related to diagnostic delay and associated injuries. 1,3 As for the classification of injuries, the American Association for Surgery of Trauma (AAST) guidelines 8 were used and they divide the extent of duodenal trauma into degrees of severity ranging from I to V according to Table 1.…”

Section: Introductionmentioning

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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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…[1][2][3] The majority of duodenal injuries are caused by penetrating trauma that requires immediate exploratory laparotomy. Blunt injuries are more diffi cult to treat, mainly because of the diffi culty in making a timely diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The use of pyloric exclusion for treating duodenal trauma: case series

et al. 2008

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CONTEXT AND OBJECTIVES: Signifi cant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING:Cross-sectional study followed by a case series in a university hospital. METHODS:Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS:The causes of the injuries included penetrating gunshot wounds (GSW) in fi ve patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fi stula (two patients).CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

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Surgical management of complex duodenal trauma using laterolateral duodenum enteroanastomosis: A case report

Galdino

Welter

Frainer

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Duodenal trauma is rare, however, it has high morbidity and mortality rates. Surgical treatment modalities are employed depending on severity, ranging from simple sutures to complex pancreaticoduodenectomy cases. Case presentation A male patient had a circular saw accident, leading to evisceration in an extensive wound from the thoracoabdominal transition to the inguinal region, with 75% laceration of the second duodenal portion circumference, laceration in hepatic segments, section from right mesocolon to transverse colon, and multiple perforations in small bowel loops between 70 and 90 cm from the angle of Treitz. Laterolateral duodenum enteroanastomosis was performed with proximal jejunum and gastroenteroanastomosis with the distal loop of the small intestine at 90 cm from the Treitz angle, and a termino lateral enteroanastomosis between food and the biliary loop at 20 cm from the gastroenteroanastomosis. Clinical discussion This report presents a new surgical technique for patients with penetrating duodenal trauma associated with liver and intestinal injuries, to avoid the need for more complex procedures. In addition, it demonstrates postoperative management of complications, including confection of the enteroatmospheric fistula for feeding. Conclusion The technique described in this article proved to be a good option for treating these lesions, as evidenced by optimal postoperative results.

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Trauma de duodeno: análise de fatores relacionados à morbimortalidade

Cited by 9 publications

References 28 publications

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

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

The use of pyloric exclusion for treating duodenal trauma: case series

Surgical management of complex duodenal trauma using laterolateral duodenum enteroanastomosis: A case report

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