Treatment of Penetrating Duodenal Injuries

Ivatury, Rao R.; Gaudino, Jean; Ascer, Enrico; Nallathambi, Manohar N.; Ramirez-Schon, Gerhart; Stahl, William M.

doi:10.1097/00005373-198504000-00011

Cited by 54 publications

(12 citation statements)

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“…Mucosal or serosal patches and a pedicled graft with a free vascular pedicle created from stomach, jejunum, or ileum tissue have been proposed without proven efficacy in any series [21,22,23,24,25]. Duodenal drainage with a decompression tube, temporary pyloric exclusion, gastrojejunostomy, feeding jejunostomy, gastric resection with external duodenal drainage with Foley or Petzer tubes have also been recommended with conflicting reports of efficacy [26,27,28]. In the presence of larger defects, Roux-en-Y duodenojejunostomy and duodenopancreatectomy procedures have been proposed too [28, 29], but when sepsis and peritonitis occur, the risk of anastomotic dehiscence is still high.…”

Section: Discussionmentioning

confidence: 99%

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

Testini¹,

Piccinni²,

Lissidini³

et al. 2008

Dig Surg

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Aim: To report our experience of managing patients affected by descending duodenal injuries secondary to laparoscopic cholecystectomy and to review the literature. Methods: Analysis of 5 cases of descending duodenal injury as a consequence of laparoscopic cholecystectomy managed between June 1992 and September 2006. Results: The median age was 59 (range 49–67) years.In all cases an emergency laparotomy showed an injury to the descending duodenum. Two patients underwent direct suture of the duodenum and external biliary drainage through a T-tube, 1 case underwent a duodenojejunostomy and in another a duodenopancreatectomy. The latter patient underwent drainage of the duodenum with a Petzer tube, followed 5 days later by gastric resection, closure of the duodenal stump and repair of the duodenal wound by suture. The median postoperative stay was 45 days and 1 patient died. Conclusion: Descending duodenal injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. The site of the descending duodenal injury is important for determining the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

Testini¹,

Piccinni²,

Lissidini³

et al. 2008

Dig Surg

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“…Routine laboratory tests are not helpful in the preoperative diagnosis of duodenal rupture. Serum amylase and lipase levels have a high false-positive and false-negative rates for duodenal trauma [1][2][3][4][5][6][7][8].…”

Section: Diagnosismentioning

confidence: 99%

“…Early diagnosis is easier after penetrating trauma, since exploratory laparotomy for peritoneal signs will lead to the correct diagnosis [1][2][3][4][5][6][7][8]. Even at celiotomy, small wounds of the duodenum may be easily overlooked.…”

Section: Diagnosismentioning

confidence: 99%

“…The surgical management of the duodenal injuries would depend on hemodynamic stability, severity of duodenal injury, and the presence and severity of associated pancreatic injury [1][2][3][4][5][6][7][8]12].…”

Section: Managementmentioning

confidence: 99%

“…The diagnosis after blunt abdominal trauma may be delayed because of subtle signs and symptoms with a resultant increase in morbidity and mortality. The management of penetrating trauma is challenging because of associated injury to major vessels of the upper abdomen [1][2][3][4][5][6][7][8]. In either type of trauma, it is essential to make an early diagnosis and apply judicious surgical principles for optimal outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Duodenal Injuries: A Review

Ivatury¹,

Malhotra²,

Aboutanos³

et al. 2007

Eur J Trauma Emerg Surg

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Duodenal injuries are uncommon injuries but are associated with significant morbidity and mortality from a delayed diagnosis in the case of blunt trauma and associated major vascular injuries in penetrating trauma. A simplistic approach with primary repair or resection and anastomosis is ideal for the vast majority. Complex procedures such as pyloric exclusion with or without gastrojejunostomy may be indicated for delayed treatment or severe, high-grade combined pancreato-duodenal injuries. A high index of suspicion and a judicious treatment plan based on a careful consideration of all the available options are crucial for optimal outcome.

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Pancreas and Duodenum Injuries: Techniques

Feliciano

2020

The Shock Trauma Manual of Operative Techniques

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Treatment of Penetrating Duodenal Injuries

Cited by 54 publications

References 0 publications

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy

Duodenal Injuries: A Review

Pancreas and Duodenum Injuries: Techniques

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