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The Journal of Surgical Research Dec 2022Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure...
INTRODUCTION
Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources.
METHODS
Data analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors.
RESULTS
The most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality.
CONCLUSIONS
Primary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management.
Topics: Humans; Vascular System Injuries; Wounds, Nonpenetrating; Abdominal Injuries; Duodenum; Hypotension
PubMed: 35961257
DOI: 10.1016/j.jss.2022.06.063 -
BMC Surgery May 2019Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient's life. DSF is related to...
BACKGROUND
Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient's life. DSF is related to high mortality (16-20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer.
METHODS
We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
RESULTS
The 20 included articles covered an approximately 40 years-study period (1979-2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21-39 days, ranging from 1 to 1035 days. Healing time was 19-63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%.
CONCLUSIONS
DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.
Topics: Abdominal Abscess; Duodenal Diseases; Gastrectomy; Humans; Intestinal Fistula; Peritonitis; Postoperative Complications; Stomach Neoplasms; Wound Healing
PubMed: 31138190
DOI: 10.1186/s12893-019-0520-x -
Journal of Gastric Cancer Mar 2016We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.
PURPOSE
We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.
MATERIALS AND METHODS
A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.
RESULTS
Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.
CONCLUSIONS
Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.
PubMed: 27104024
DOI: 10.5230/jgc.2016.16.1.28 -
Pediatric Surgery International Aug 2018To summarize the clinical characteristics, diagnosis, treatment and prognosis among 152 children with annular pancreas (AP). A retrospective review of 152 patients with...
To summarize the clinical characteristics, diagnosis, treatment and prognosis among 152 children with annular pancreas (AP). A retrospective review of 152 patients with AP who were treated with surgical repair between January 2009 and August 2017 was performed at our pediatric surgical units. Presenting symptoms, birth weight, radiological findings, associated anomalies, the type of surgery performed were analyzed. (1) 152 patients were identified, out of which 82 were males, and 70 were females; (2) the average birth weight of children with AP was less than that of healthy newborns. The birth weights of 5.4% premature infants were less than 1500 g; the birth weight of 17% full-term infants, 69% premature infants and 50% post-term infants were less than 2500 g. (3) 100 (66%) patients presented symptoms during neonatal period and 43 (28%) patients had duodenal obstruction diagnosed by prenatal ultrasound scan. (4) All cases were managed surgically by open laparotomy, and all patients were duly discharged. AP most commonly presents symptoms in early neonatal period. Infants with AP are associated with a higher rate of low birth weight, and it was because swallowed amniotic fluid could not be absorbed and impaired insulin secretion caused by abnormal pancreas. Ultrasonography, abdominal plain film and upper gastrointestinal series (UGI) are helpful, but cannot make the diagnosis, and surgery is the only effective way to diagnose and treat AP.
Topics: Birth Weight; China; Chromosome Aberrations; Digestive System Abnormalities; Duodenal Obstruction; Duodenostomy; Female; Heart Defects, Congenital; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Pancreas; Pancreatic Diseases; Retrospective Studies; Urinary Tract
PubMed: 29909441
DOI: 10.1007/s00383-018-4299-0 -
Gastrointestinal Endoscopy Feb 2017
Topics: Anastomosis, Surgical; Biliary Tract Surgical Procedures; Cholecystostomy; Choledochostomy; Cholestasis; Duodenostomy; Endoscopy, Digestive System; Gastrostomy; Humans; Jejunostomy; Self Expandable Metallic Stents
PubMed: 28089036
DOI: 10.1016/j.gie.2016.08.024 -
African Journal of Paediatric Surgery :... 2022Pre-duodenal portal vein (PDPV) is a rare anomaly and a rare cause of duodenal obstruction (DO), with only a few cases reported in the literature. We present an infant...
Pre-duodenal portal vein (PDPV) is a rare anomaly and a rare cause of duodenal obstruction (DO), with only a few cases reported in the literature. We present an infant whose bilious vomiting persisted despite having Ladd's procedure for intestinal malrotation due to a missed diagnosis of DO from PDPV that was found at re-exploration. The patient was diagnosed with malrotation and had Ladd's procedure at 12 weeks of age, but bilious vomiting persisted post-operatively. The patient presented to us after 4 weeks, was clinically malnourished and dehydrated, resuscitation was done and re-exploratory laparotomy performed, where an obstructing PDPV was found and a duodeno-duodenostomy was performed anterior to PDPV. However, the patient died on post-operative day 7 probably from severe malnutrition due to delayed diagnosis and absence of parenteral nutrition. We conclude that PDPV may be a cause of DO in infants with malrotation and should be properly sought for during Ladd's procedure for possible bypass surgery if found.
Topics: Duodenal Obstruction; Humans; Infant; Intestinal Obstruction; Laparotomy; Parenteral Nutrition; Portal Vein; Vomiting
PubMed: 35017382
DOI: 10.4103/ajps.AJPS_146_20 -
Journal of Gastrointestinal Surgery :... Aug 2016The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease.
BACKGROUND
The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease.
RESULTS
Sixty-seven patients were identified including 15 children and 52 adults; 76.1 % were females. The median age at diagnosis was 3 [inter-quartile range (IQR) = 6.0-0.7] years for children, and 46 [IQR = 55.6-34.3] years for adults. Forty-eight patients (72 %) were symptomatic. Types of choledochal cyst included: I (n = 49, 73.1 %), II (n = 1, 1.5 %), IV (n = 9, 13.4 %), and V (n = 8, 12 %). The median diameter of the type I choledochal cyst was 35 [IQR = 47-25] mm. All 48 patients underwent excision of cyst with Roux-en-Y hepaticojejunostomy, and eight underwent resection with hepaticoduodenostomy. Six patients underwent liver resection, and five patients underwent orthotopic liver transplantation. Malignancy was concomitant in five adult patients, being identified on preoperative imaging in three cases; and atypia was seen in three additional patients. Early morbidity included Clavien-Dindo classification grades III (n = 7) and II (n = 5), while long-term complications consisted of Clavien-Dindo grades V (n = 5), IV (n = 2), III (n = 18), and II (n = 1).
CONCLUSIONS
Presentation and management of choledochal cyst is varied. Malignant transformation is often detected incidentally, and so should be the driving source for resection when a choledochal cyst is diagnosed.
Topics: Adult; Anastomosis, Roux-en-Y; Anastomosis, Surgical; Child; Child, Preschool; Choledochal Cyst; Duodenostomy; Female; Humans; Infant; Liver; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Retrospective Studies
PubMed: 27260526
DOI: 10.1007/s11605-016-3181-4 -
Journal of Gastroenterology and... Mar 2017
Topics: Anastomosis, Roux-en-Y; Duodenal Obstruction; Duodenal Ulcer; Duodenostomy; Endoscopy, Gastrointestinal; Humans; Jejunostomy; Laparoscopy; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Gastrointestinal; Tuberculosis, Pulmonary; Vomiting
PubMed: 28320066
DOI: 10.1111/jgh.13584 -
Surgery Oct 2017Total resection of the jejunum and ileum, a rarely performed procedure, is indicated after mesenteric vascular events, trauma, or resection of abdominal neoplasms. We...
BACKGROUND
Total resection of the jejunum and ileum, a rarely performed procedure, is indicated after mesenteric vascular events, trauma, or resection of abdominal neoplasms. We describe our recent experience with the operative and medical management of patients with "no gut syndrome."
METHODS
We retrospectively reviewed 341 adult patients who were referred to our center between January 2013 and December 2016.
RESULTS
Thirteen patients with a mean age of 42.5 years (range 17 to 66 years) underwent near total enterectomy. Indications for small bowel resection were vascular event (n = 5), intraabdominal fibroid/desmoid (n = 4), and trauma (n = 4). Foregut secretions were managed with duodenocolostomy (n = 5), tube decompression (n = 5), and end duodenostomy (n = 2). Duodenal stump was stapled off in 4 cases. One patient underwent a spleen-preserving duodenopancreatectomy combined with total enterectomy. Biliary secretions were managed with choledochocolostomy. All patients were discharged on full total parenteral nutrition infused over a 10- to 16-hour period. Average total parenteral nutrition volume and caloric requirement were 2,800 mL/day (range 2,000 to 4,000) and 1,774 Kcal/day (range 1,443 to 2,290), respectively. Patients who underwent duodenocolonic anastomosis received smaller TPN volume (33.8 vs 49.8 mL/kg). Ten patients (77%) required supplemental intravenous fluid. There were no intraoperative or perioperative deaths. One patient was lost to follow-up 2 months after operation. After a 20-month median follow-up (range 4 to 48 months), 9 patients are still alive (75%). All patients with duodenocolostomy remain alive (median follow-up 36.4 months). Three patients underwent uneventful isolated small bowel transplantation, and another 4 are being evaluated or are already listed for visceral transplantation.
CONCLUSION
In summary, resection of the entire small bowel is feasible and can be a lifesaving procedure for a select group of patients. Long-term survival can be achieved in specialized centers. In addition, reestablishment of gastrointestinal tract continuity after total enterectomy appears to be the best option for postoperative fluid and electrolyte management.
Topics: Adolescent; Adult; Aged; Digestive System Surgical Procedures; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Parenteral Nutrition, Total; Retrospective Studies; Short Bowel Syndrome; Treatment Outcome; Young Adult
PubMed: 28755968
DOI: 10.1016/j.surg.2017.05.012 -
Annals of Hepato-biliary-pancreatic... Feb 2018A residual gallbladder (RGB) following a partial/subtotal cholecystectomy may cause symptoms that require its removal. We present our large study regarding the problem...
BACKGROUNDS/AIMS
A residual gallbladder (RGB) following a partial/subtotal cholecystectomy may cause symptoms that require its removal. We present our large study regarding the problem of a RGB over a 15 year period.
METHODS
This study involved a retrospective analysis of patients managed for symptomatic RGB from January 2000 to December 2015.
RESULTS
A RGB was observed in 93 patients, who had a median age of 45 (25-70) years, and were comprised of 69 (74.2%) females. The most common presentation was recurrence pain (n=64, 68.8%). Associated choledocholithiasis was present in 23 patients (24.7%). An ultrasonography (USG) failed to diagnose RGB calculi in 10 (11%) patients; whereas, magnetic resonance cholangio-pancreatography (MRCP) accurately diagnosed RGB calculi in all the cases except for 2 (4%) and, additionally, detected common bile duct (CBD) stones in 12 patients. Completion cholecystectomy was performed in all patients (open 45 [48.4%]; laparoscopic 48 [51.6%] and 19 [20.4%] patients required a conversion to open). The RGB pathology included stones in 90 (96.8%), Mirizzi's syndrome in 10 (10.8%) and an internal fistula in 9 (9.7%) patients. Additional procedures included CBD exploration (n=6); Choledocho-duodenostomy (n=4) and Roux-en-Y hepatico-jejunostomy (n=3). The mortality and morbidity were nil and 11% (all wound infection), respectively. Two patients developed incisional hernia during follow up. The mean follow up duration was 23.1 months (3-108) in 65 patients and the outcome was excellent and good in 97% of the patients.
CONCLUSIONS
Post-cholecystectomy recurrent biliary colic should raise suspicion of RGB. MRCP is a useful investigation for the diagnosis and assessment of any associated problems and provides a roadmap for surgery. Laparoscopic completion cholecystectomy is feasible, but is technically difficult and has a high conversion rate.
PubMed: 29536054
DOI: 10.14701/ahbps.2018.22.1.36