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Major duodenal injuries in children: diagnosis, operative management, and outcome
Insights
Pediatric duodenal injuries, often from blunt trauma, require prompt surgical intervention. Surgical outcomes for children with duodenal injuries are generally good, with most recovering well after complex reconstructions or primary closures.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Major duodenal injuries in children are rare but can result from penetrating or blunt trauma.
- Delayed diagnosis is common in blunt trauma cases due to vague initial symptoms.
Purpose of the Study:
- To review the diagnosis, treatment, and outcomes of pediatric patients (<13 years) with major duodenal injuries.
- To evaluate surgical strategies and their effectiveness in managing these complex injuries.
Main Methods:
- Retrospective review of ten pediatric patients (<13 years) undergoing surgery for major duodenal injuries.
- Analysis of injury mechanisms (gunshot wounds vs. blunt trauma), surgical procedures, and patient outcomes.
Main Results:
- Seven blunt trauma cases included massive injuries (3) and lesser injuries (4) with delayed presentation.
- Eight patients had associated injuries, most commonly pancreatic.
- Surgical interventions ranged from Whipple reconstruction and pyloric exclusion with gastrojejunostomy to debridement and primary closure, with varying fistula rates.
Conclusions:
- Prompt surgical management is crucial for pediatric duodenal injuries.
- Complex reconstructions can achieve good outcomes, while primary closure may lead to fistulas.
- Nutritional support is vital for recovery.
Abstract:
The diagnosis, treatment, and outcome of ten children less than 13 years old operated on for major duodenal injuries is reviewed. Three had gun shot wounds with perforation and seven had blunt trauma resulting in duodenal disruption. Of those with blunt trauma, three had massive injuries requiring immediate operation, and four had what appeared to be lesser injuries. The symptoms of those children with lesser injuries were initially vague and delayed in onset, resulting in a delay of 24 hours to 7 days from time of injury to admission. At the time of admission, all four had tenderness localized to the right lower quadrant and an unclear preoperative diagnosis. Eight had associated injuries, most commonly to the pancreas. The single death occurred within 48 hours of injury and was the result of an associated head injury. The surviving nine patients left the hospital between the 11th and 22nd postoperative day doing well. One patient with a transected pancreas and extensive duodenal injury underwent a pancreaticoduodenectomy with a Whipple type reconstruction. Two patients with an extensive blowout injury to the duodenum and one with a crush injury to the pancreas underwent a pyloric exclusion and gastrojejunostomy. These patients did well with no fistula formation. The remaining seven children underwent debridement and primary closure of the duodenal injury. Four developed fistulae; however, two were pancreatic, one was jejunal, and only one was duodenal. All drained less than 250 mL per 24 hours and all except the jejunal fistula were closed by the 17th postoperative day. All were supported nutritionally either intravenously or more recently with a jejunal catheter placed at operation.(ABSTRACT TRUNCATED AT 250 WORDS)