Traumatic Injuries to the Duodenum

Abstract

Data of 98 patients who had sustained traumatic injuries to the duodenum during a recent 7-year period is reviewed. The overall mortality was 23.5%; that of the blunt injury group was 35%, that of the penetrating injury group was 20%. However, after the establishment of a trauma unit, the mortality for duodenal injuries fell from 32% to 12%. Death from duodenal wounds may be reduced by earlier hospitalization, earlier diagnosis and consequently earlier surgical repair. Vigorous treatment of shock is essential. A specialized trauma unit with personnel experienced in the management of shock and trauma problems provides a better environment to carry out the preoperative and postoperative care of the acutely injured patient. Adequate surgical treatment of the blunt injury and missile injury of the duodenum should consist of the following procedures: 1) repair of the duodenal wall utilizing conventional techniques; 2) internal decompression of the repair by afferent jejunostomy; 3) efferent jejunostomy for postoperative feeding; 4) temporary gastrostomy; and 5) external drainage of the repair. In certain selected instances, the simple stab wound of the duodenum may be treated by conventional repair without decompression, but a loop of jujunum should be sutured over the repair to prevent delayed disruption. The majority of patients with injuries to the duodenum have associated organs injured which also require considered surgical judgment and action.

Biliogastric Diversion for the Management of High-Output Duodenal Fistula: Report of Two Cases and Literature Review

“…Suturing of the duodenum wall in one or two layers, with or without serosal patch, is performed by many surgeons as the primary operation, 32,33 unfortunately with poor results in many cases due to the formation of a duodenal wall defect followed by sepsis and high-output duodenal fistula. 20 Numerous surgical procedures have been described with varietal results for the management of the high-output fistulas: triple ostomies, 34,35 various grafts (small bowel, gastric wall, rectus and transversalis muscle), 2,7,36 pyloric exclusion, 37,38 clips, 39 and even radical procedures like Billroth II, Roux-en-Y gastrojejunostomy, Longmire's, and Whipple's. [40][41][42][43] Continuous intraluminal aspiration and infusion with feeding jejunostomy gave good results in the past.…”

Resection of the Angle of Treitz and Distal Diverticulization of the Duodenum in Penetrating Abdominal Injuries

“…At laparotomy, the entire duodenum must be explored to avoid overlooking an injury. Duodenal injury should be considered in the presence of other major intra-abdominal injury, with which it is normally associated [1, 35]. …”

“…It is associated with a mortality of between 0 and 46% [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]. Although this is usually due to associated injuries [3, 9, 12, 13, 15, 17]and significantly worse when there is an associated pancreatic injury [3, 7, 10, 15, 18, 19], it may result from the duodenal injury through fistula and sepsis [9, 12, 15, 20, 21].…”

Lesiones duodenales secundarias a traumatismo: revisión de la literatura

“…Las lesiones por aplastamiento normalmente ocurren cuando una fuerza directa es aplicada contra la pared abdominal y transmitida al duodeno, que es proyectada posteriormente contra la columna vertebral sobre la cual yace, como cuando el volante del automó vil impacta contra el epigastrio. Tambié n ocurren cuando la porció n mó vil y no mó vil del duodeno sufren movimientos de aceleració n y desaceleració n, como ocurre durante una caída desde gran altura [2][3][4][5][6][7] .…”