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[Posttraumatic duodenal lesions in children. The therapeutic considerations]
C Sabetay1, F Purcaru, O Angheloiu
1Facultatea de Medicină Craiova, Clinica Chirurgie, Ortopedie Pediatrică.
Insights
Pediatric duodenal lesions are rare surgical cases. This study details 4 cases, highlighting successful management of complications like duodenal fistulae with intensive care and surgical interventions.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Intensive Care Medicine
Background:
- Posttraumatic duodenal lesions in children are uncommon surgical emergencies.
- These injuries often present with complex challenges requiring multidisciplinary care.
Observation:
- Four pediatric cases of duodenal lesions were managed, with two experiencing postoperative duodenal fistulae.
- Initial lesions were retroperitoneal, complicating diagnosis and treatment.
- Intensive Care Unit (ICU) therapy focused on shock, immediate post-operative care, and late complications.
Findings:
- Successful management involved intensive care addressing traumatic/septic shock, post-operative support, and nutritional deficiencies.
- Surgical interventions included catheterization, gastro-duodenal aspiration, and fistula management via catheters and sutures.
- Prompt and comprehensive ICU and surgical care led to favorable outcomes.
Implications:
- This case series underscores the importance of specialized pediatric surgical and intensive care for managing rare duodenal injuries.
- Effective treatment strategies for posttraumatic duodenal fistulae in children can be achieved through combined ICU and surgical approaches.
- The findings suggest that early recognition and tailored management are crucial for improving outcomes in pediatric duodenal trauma.
Abstract:
The posttraumatic lesions of the duodenum in children represent rare cases in the surgical field. 4 cases of duodenal lesions were registered and operated upon in the Pediatric Surgery and Orthopedic Clinic, in cooperation with the ICU Clinic, 2 of them having postoperative complications (duodenal fistulae), these cases being initially situated in a retroperitoneal position (lateral and posterior). The ICU therapy was directed in the first step towards the traumatic and septic shock, in the second one to the immediate postoperative care and in the third step towards late complications. For the 2 cases having postoperative complications, the care was directed towards the elements of local complications (retroperitoneal abscess, fistulae), MSOF, sustaining the immune system correcting the nutritional deficiencies. Surgical methods used for sustaining the ICU therapy were: endovenous catheterisation, gastro-duodenal aspiration, solving the fistulae through catheters and suture. The results, using the methods described above, were good.