Duodenal injuries: how to deal with it?

Abstract

Objective The aim of this study was to report on a series of nine cases of duodenal repairs using different modalities and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. Patients and methods This was a cross-sectional study conducted on nine cases of duodenal repairs using different modalities. A total of 50 patients with penetrating or blunt abdominal trauma and duodenal injury were admitted to the emergency department of Minia University Hospital between March 2012 and December 2014. All of the known cases of duodenal trauma among these patients were reviewed. Results The mean age of the patients was 35.2΁10.9 years. The time elapsed from admission to the surgical intervention ranged from 20 min to 10 h, and the median time was 90 min. Postoperative complications were common and occurred in five patients. Length of hospital stay ranged from 7 to 90 days and the median length was 17 days. Primary repair, segmental resection, primary end-to-end duodenoduodenostomy, duodenal diverticulization, direct anastomosis of Roux-en-Y over the injury in an end-to-side manner, and pancreaticoduodenectomy were performed on the basis of the condition of the cases. Conclusion Most duodenal injuries can be managed by means of simple repair. More complicated injuries need more sophisticated operation techniques and are followed by a high incidence of postoperative complications, especially duodenal fistula and high mortality.