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The British Journal of Surgery Nov 2000The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma. (Review)
Review
BACKGROUND
The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma.
METHODS
The English language literature on duodenal trauma over the period 1970-1999 was reviewed.
RESULTS AND CONCLUSION
Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair. More complicated injuries require more sophisticated techniques. High-risk duodenal injuries are followed by a high incidence of suture line dehiscence and they should be treated by duodenal diversion. Pancreaticoduodenectomy should be considered only if no alternative is available. 'Damage control' should precede definitive reconstruction.
Topics: Duodenum; Hematoma; Humans; Pancreaticoduodenectomy; Risk Factors; Surgical Wound Dehiscence; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 11091233
DOI: 10.1046/j.1365-2168.2000.01594.x -
JBR-BTR : Organe de La Societe Royale... 2011
Topics: Aged; Contrast Media; Diagnosis, Differential; Duodenitis; Duodenum; Humans; Male; Stomach Ulcer; Tomography, X-Ray Computed; Varicose Veins
PubMed: 21699046
DOI: 10.5334/jbr-btr.506 -
Abdominal Radiology (New York) Jan 2020
Review
Topics: Duodenal Diseases; Duodenum; Hematoma; Humans; Tomography, X-Ray Computed
PubMed: 31378827
DOI: 10.1007/s00261-019-02166-1 -
The American Surgeon Apr 2023Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal...
BACKGROUND
Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center.
METHODS
A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted.
RESULTS
After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy.
CONCLUSION
Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
Topics: Humans; Male; Adult; Female; Retrospective Studies; Duodenum; Duodenal Diseases; Abdominal Injuries; Wounds, Nonpenetrating; Hematoma
PubMed: 33596103
DOI: 10.1177/0003134821995054 -
Revista Espanola de Enfermedades... Apr 202459-year-old man, smoker, diabetic and hypertensive. He went to the ER due to fixed abdominal pain in the epigastrium, diaphoresis, dizziness, nausea, and "coffee...
59-year-old man, smoker, diabetic and hypertensive. He went to the ER due to fixed abdominal pain in the epigastrium, diaphoresis, dizziness, nausea, and "coffee grounds" vomiting. On examination he presented abdominal distension and pain on palpation in the epigastrium, without peritonism. He had a BP of 235/100 mmHg and in the blood-tests, leukocytosis with neutrophilia and normal hemoglobin. An urgent abdominal CT scan was performed, identifying a 5x6 cm nodular lesion of homogeneous density attached to the wall of the second and third duodenal portions that compressed the lumen, with two vessels with active bleeding within it. Therefore, percutaneous embolization of the gastroduodenal artery was performed. Subsequently, the patient suffered an episode of severe acute pancreatitis that required ICU admission. Finally, he presented a good clinical evolution with ceasing of pain, complete reabsorption of the hematoma and resolution of the obstructive symptoms.
Topics: Male; Humans; Acute Disease; Pancreatitis; Hematoma; Duodenal Diseases; Gastrointestinal Hemorrhage; Abdominal Pain; Hematemesis
PubMed: 37706445
DOI: 10.17235/reed.2023.9793/2023 -
Pediatrics and Neonatology Jan 2023
Topics: Humans; Duodenal Diseases; Gastrointestinal Hemorrhage; Hematoma
PubMed: 36002379
DOI: 10.1016/j.pedneo.2022.07.003 -
Current Problems in Surgery Nov 1993
Review
Topics: Duodenum; Hematoma; History, 19th Century; History, 20th Century; Humans; Rupture; Survival Rate; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 8222749
DOI: 10.1016/0011-3840(93)90063-m -
Annals of Emergency Medicine Jan 1982
Topics: Abdominal Injuries; Adolescent; Diagnosis, Differential; Duodenal Diseases; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Radiography
PubMed: 6976767
DOI: 10.1016/s0196-0644(82)80011-5 -
Journal of Pediatric Surgery Jun 2004The natural history and management of pediatric duodenal injuries are incompletely described. This study sought to review injury mechanism, surgical management, and... (Review)
Review
BACKGROUND/PURPOSE
The natural history and management of pediatric duodenal injuries are incompletely described. This study sought to review injury mechanism, surgical management, and outcomes from a collected series of pediatric duodenal injuries.
METHODS
A retrospective chart review was conducted for a 10-year period of all children less than 18 years old treated for duodenal injuries at 2 pediatric trauma centers.
RESULTS
Forty-two children were treated for duodenal injuries. There were 33 blunt and 9 penetrating injuries. Injuries were classified using the Organ Injury Scale for the Duodenum. Twenty-four patients underwent operative management by primary repair (18), duodenal resection and gastrojejunostomy (4), or pyloric exclusion (2). Duodenal hematomas were treated nonoperatively in 94% of cases. The average ISS for operative versus nonoperative cases was 23 and 10, respectively. Delay in diagnosis or operative intervention (>24 hours) was associated with increased complication rate (43% v 29%) and hospitalization (32 v 20 days). Nine children requiring surgery experienced delays and were most highly associated with foreign body, child abuse, and bicycle injuries. There were no deaths caused by duodenal injuries.
CONCLUSIONS
Duodenal injuries in children were predominantly blunt and had a low mortality rate. When surgery was required, primary repair was usually feasible.
Topics: Accidents; Adolescent; Case Management; Child; Child Abuse; Child, Preschool; Duodenum; Female; Foreign Bodies; Gastrointestinal Hemorrhage; Hematoma; Hospitals, Pediatric; Humans; Infant; Lacerations; Length of Stay; Male; Multiple Trauma; Philadelphia; Postoperative Complications; Retrospective Studies; Trauma Centers; Trauma Severity Indices; Utah; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 15185235
DOI: 10.1016/j.jpedsurg.2004.02.032 -
Cirugia Y Cirujanos 2019There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is... (Review)
Review
There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment.
Topics: Abdominal Injuries; Accidents, Traffic; Adult; Colectomy; Duodenum; Gastrostomy; Hematoma; Hemoperitoneum; Humans; Ileum; Ischemia; Jejunostomy; Lacerations; Liver; Male; Mesentery; Parenteral Nutrition; Pneumoperitoneum; Wounds, Nonpenetrating
PubMed: 31501625
DOI: 10.24875/CIRU.19000779