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Complex penetrating duodenal injuries: less is better.

Carlos Ordoñez1, Alberto García, Michael W Parra

  • 1From the Departamento de Cirugía (L.F.P.) and Unidad de Cuidado Intensivo (C.O., A.G.), and Unidad de Investigaciones Clínicas (M.B., J.S.), Fundación Valle del Lili; Departamento de Cirugía (C.O., A.G., D.S., L.F.P., M.M., F.R., R.F.), Universidad del Valle, Cali, Colombia; Division of Trauma Critical Care (M.W.P.), Broward General Level I Trauma Center/Delray Provisional Level I Trauma Center, Delray Beach, Florida; and Department of Surgery (J.C.P.), University of Pittsburgh, Pittsburgh, Pennsylvania.

The Journal of Trauma and Acute Care Surgery
|April 22, 2014
PubMed
Summary

Simplified surgical approaches for penetrating duodenal trauma (PDT) improve survival rates. Basic damage-control techniques offer an effective strategy for managing complex PDT injuries with acceptable complication rates.

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Area of Science:

  • Trauma Surgery
  • Gastrointestinal Surgery
  • Surgical Outcomes

Background:

  • Traditional management of complex penetrating duodenal trauma (PDT) involves elaborate procedures like pyloric exclusion and duodenal diverticulization.
  • A simplified surgical approach was investigated to improve clinical outcomes in complex PDT injuries.

Purpose of the Study:

  • To evaluate the effectiveness of a simplified surgical algorithm for managing complex penetrating duodenal trauma.
  • To compare outcomes of different surgical strategies in PDT patients.

Main Methods:

  • Retrospective review of 44 consecutive PDT cases from 2003-2012.
  • Patients categorized into groups based on a simplified surgical algorithm, including primary duodenal repair and damage-control laparotomy.
  • Postoperative duodenal leaks managed with anterior drainage or posterior retroperitoneal laparostomy.

Main Results:

  • Of 36 eligible patients (mostly gunshot wounds), 19.4% had primary repair without damage control, while 80.5% underwent damage-control laparotomy.
  • The most common complication was duodenal fistula (33%), managed with drainage; 58.3% closed spontaneously.
  • Duodenum-related mortality was 2.8%, and overall mortality was 11.1%.

Conclusions:

  • Applying basic damage-control techniques in penetrating duodenal trauma management improves survival.
  • A simplified surgical approach demonstrates an acceptable incidence of complications for complex PDT.