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Complicated duodenal perforation in children: Role of T-tube
Rupesh Keshri1, Digamber Chaubey1, Ramdhani Yadav1
1Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Insights
T-tube repair for pediatric duodenal perforation (DP) in children with delayed diagnosis and severe injury leads to better outcomes. This surgical technique ensures tension-free healing and reduces complications in complex cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Trauma Surgery
Background:
- Delayed diagnosis of duodenal perforation (DP) in children complicates treatment and worsens outcomes.
- Effective surgical management strategies for pediatric DP are crucial.
Observation:
- A retrospective study analyzed nine pediatric patients with duodenal perforation (DP) managed between 2016 and 2020.
- Causes of DP included blunt abdominal trauma, foreign body ingestion, iatrogenic injury, and unknown etiologies.
- Four of five patients with blunt abdominal trauma and large perforations required T-tube repair due to bowel edema.
Findings:
- Repair over a T-tube was successful in managing complex pediatric duodenal perforations, including those with large defects and edema.
- T-tube closure facilitated tension-free healing and reduced post-operative complications in selected cases.
- Primary repair with Graham's patch was effective for two patients with unknown causes of DP.
Implications:
- T-tube placement is a valuable technique for managing severe pediatric duodenal perforations, especially in cases with delayed presentation and significant tissue edema.
- This approach can improve healing and minimize complications in challenging pediatric surgical cases.
- Further research into optimal surgical timing and techniques for pediatric DP is warranted.
Background:
Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure.
Objectives:
To explore the advantages of using T-tube in surgeries for DP in children.
Patients And Methods:
A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected. Patients, with closure over a T-tube to ensure tension-free healing, were critically analysed.
Results:
A total of nine DP patients with ages ranging from 2 years to 9 years were managed. Five (55.6%) patients had blunt abdominal trauma; a 2-year-old male had perforation following accidental ingestion of lollypop-stick while a 3-year-old male had DP during endoscopic evaluation (iatrogenic) of bleeding duodenal ulcers; cause could not be found in other 2 (22.2%) patients. Of the five patients with blunt abdominal trauma, 4 (80%) had large perforation with oedematous bowel, necessitating repair over T-tube. Both patients with unknown causes had uneventful outcomes following primary repair with Graham's patch. Patients with lollypop-stick ingestion and iatrogenic perforation did well with repair over T-tube. The only trauma patient with primary repair leaked but subsequently had successful repair over a T-tube. One patient with complete transection of the third part of the duodenum and pancreatic injury who had repair over T-tube died due to secondary haemorrhage on the 10th post-operative day.
Conclusion:
Closure over a T-tube in DP, presenting late with oedematous bowel, ensures low pressure at the perforation site, forms a controlled fistula and promotes healing, thereby lessening post-operative complications.
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