Conservative Management of Duodenal Trauma: A Multicenter Perspective.
COGBILL, THOMAS H. M.D. 1; MOORE, ERNEST E. M.D. 2; FELICIANO, DAVID V. M.D. 3; HOYT, DAVID B. M.D. 4; JURKOVICH, GREGORY J. M.D. 6; MORRIS, JOHN A. M.D. 6; MUCHA, PETER JR., M.D. 7; ROSS, STEVEN E. M.D. 8; STRUTT, PAMELA J. R.N. 1; MOORE, FREDERICK A. M.D. 2; SPJUT-PATRINELY, VICKY R.N. 3; TELLEZ, MARK G. M.D. 4; OFFNER, PATRICK J. M.D. 5; WILCOX, TODD B.S. 6; FARNELL, MICHAEL B. M.D. 7; O'MALLEY, KEITH F. M.D. 8
Journal of Trauma-Injury Infection & Critical Care.
30(12):1469-1475, December 1990.
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The experience of eight trauma centers with duodenal injuries was analyzed to identify trends in operative management, sources of duodenal-related morbidity, and causes of mortality. During the 5-year period ending December 1988, 164 duodenal injuries were identified. Patient ages ranged from 5 to 78 years. There were 38 Class I, 70 Class II, 48 Class III, four Class IV, and four Class V injuries. Injury mechanism was penetrating in 102 (62%) patients and blunt in 62. Primary repair of the duodenal injury was performed in 117 (71%) patients, including 27 patients also managed with pyloric exclusion and 12 with tube duodenostomy. Duodenal resection with primary anastomosis was used in six (4%) patients and pancreatoduodenectomy was necessary in five (3%).
There were 30 (18%) deaths. The cause of death was uncontrolled hemorrhage from severe hepatic or vascular injuries in 22 (73%) patients. In only two (1%) patients could death be attributed to the duodenal injury; each as the result of duodenal repair dehiscence and subsequent sepsis. Duodenal-related morbidity was documented in 29 (18%) patients, including 22 patients with intra-abdominal abscess, six with duodenal fistula, and five with frank duodenal dehiscence.
In summary, this analysis demonstrated: 1) the great majority of duodenal injuries can be managed by simple repair; 2) tube duodenostomy is not a mandatory component of operative treatment; 3) pyloric exclusion is a useful adjunct for more complex injuries; 4) pancreatoduodenectomy is rarely necessary for civilian duodenal trauma; 5) morbidity following duodenal trauma is more dependent on associated intra-abdominal injuries than the extent of duodenal trauma; and 6) mortality following duodenal injuries is primarily related to associated vascular and hepatic trauma.
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