[Surgical tactics in duodenal trauma]

Area of Science:

• Gastroenterology and Surgical Traumatology
• Digestive System Surgery
• Abdominal Trauma Management

Background:

• Duodenal injuries present significant surgical challenges.
• Causes range from penetrating wounds to iatrogenic trauma during endoscopic procedures.
• High complication and mortality rates necessitate optimized treatment strategies.

Observation:

• Analysis of 61 patients with duodenal injuries: stab wounds (24), missile wounds (7), closed trauma (26), and endoscopic papillosphincterotomy complications (4).
• Overall complication rate was 52.5%, with a 34.4% mortality rate (21 deaths).
• Early deaths (within 24 hours) were primarily due to severe combined trauma and blood loss.

Findings:

• Purulent complications (retroperitoneal phlegmon, pancreatitis, pneumonia) significantly contribute to unfavorable outcomes.
• Adequate incision and drainage of infected retroperitoneal tissues are vital.
• Duodenal decompression via tube effectively prevents suture insufficiency and pancreatitis; octreotide aids in suppressing pancreatic and duodenal secretions.

Implications:

• Effective management requires timely diagnosis and surgical intervention tailored to injury type.
• Implementing specific surgical techniques like adequate drainage and duodenal decompression can mitigate complications.
• Further research into optimizing surgical and medical management protocols for duodenal injuries is warranted.