Diagnosis Of Duodenal Injury Research Articles

Duodenal lesions management

Penetrating injuries are more typical overall, and traumatic damage to the duodenum only happens in 3 to 5% of individuals with abdominal injury. The majority of blunt injuries in the US are brought on by auto accidents. Lesions are evenly dispersed across the other sections of the duodenum, with the second segment being more frequently afflicted. Duodenal damage symptoms are non-specific and could be less noticeable after retroperitoneal surgery. Computed tomography (CT) is used to evaluate the duodenum in the diagnosis of duodenal injury in hemodynamically stable patients. CT findings related to this evaluation include duodenal thickening, periduodenal fluid, extraluminal air, and accumulation of heterogeneous fluid (clot) close to the site of injury. According to the mechanism and severity of the damage, the care of duodenal lesions should be cautious in patients with grade I or grade II closed duodenal hematoma who are hemodynamically stable. When duodenal lesions need to be repaired, surgery is necessary. With death rates of about 15%, duodenal injury complications include intra-abdominal abscess, duodenal fistula, and post-traumatic pancreatitis.

A NEW SURGICAL TECHNIQUE FOR PREVENTION OF LEAKAGE AFTER DUODENAL REPAIRS

Background: Duodenal injuries, due to their retroperitoneal location, are a diagnostic challenge to the surgeon; for this reason, they are identified in a late stage, and thus associated with increased morbidity and mortality. The diagnosis of duodenal injury requires a high level of suspicion. Delayed diagnosis and management of these injuries results in increased morbidity and mortality rates. It must be remembered that the retroperitoneal location of the duodenum usually precludes early detection of injury by physical examination, which is characterised by minimal findings. Signs of defence, abdominal rigidity and absence of bowel sounds indicate intra-abdominal injury and lead to a surgical procedure. There are many different surgical procedures based on injury complexity, one of which is the tube duodenostomy technique. Despite the advances in surgical technique, duodenal lesions are still associated with high morbidity and mortality rates. Purpose: The purpose of this presentation is to describe a new surgical technique in the management of duodenal injuries. Surgical Technique: The technique was performed on a patient, presented with Crohn’s disease together with intestinal tuberculosis, in the management of duodenal injury secondary to duodenocolic fistula and abscess during the postoperative follow-up. The patient was operated on due to invagination, intra-abdominal abscess and general condition deterioration. The second operation was performed because of contrast extravasation from the duodenum. Especially the third part of the technique, application of negative pressure through a tube enterostomy in order to prevent the accumulation of secretions and pressure increase in the duodenum, minimized the intra-duodenal pressure and decreased the risk of anastomotic dehiscence and fistula formation (Figure 1). For this purpose, continuous negative aspiration was performed with an aspiration cannula extended through the enterostomy tube during the first 14 days. The patient was recovered without any complications. Conclusion: The authors concluded that this new technique of “pyloric exclusion, the repair of the mucosal layer of the primary wound in the duodenum with a stapler and of serosa with vicryl, minimizing intra-duodenal pressure by applying negative pressure with the enterostomy tube” can be considered to be an alternative solution for duodenal injuries.

Operative blunt duodenal injury in children: a multi-institutional review

Background/AimOperative blunt duodenal injury in children is rare. The purpose of this analysis is to describe the clinical presentation, current management, and outcome of children with operative blunt duodenal injury. MethodsThe American Pediatric Surgical Association Trauma Committee solicited data from its members on children with blunt intestinal injuries identified at autopsy or operation from January 2002 through August 2006. ResultsFifty-four children from 16 hospitals with operative blunt duodenal injuries were identified: 0.67 patients per hospital per year. The most common mechanisms of injury were motor vehicle crashes (35%), bicycle crashes (22%), and nonaccidental trauma (20%). Forty-nine patients (90%) had positive physical examination findings on initial presentation, including peritonitis in 18 patients (33%). Twenty-five computed tomographic (CT) scans performed demonstrated free fluid, and 13 (52%), free air. Eleven CT scans used enteral contrast, and only 2 (18%) showed extravasation. Fifty-two patients (96%) survived to operation. The overall complication rate was 42%. ConclusionOperative blunt duodenal injury occurs less than once per year in the typical pediatric trauma center. Most of the patients have pertinent physical examination findings on arrival. Computed tomographic scans with enteral contrast do not seem to be helpful in diagnosis of duodenal injuries. Postoperative complications are frequent, but most children survive.