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Published on: December 20, 2024
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Management of the complex duodenal injury
Toba Bolaji1, Asanthi Ratnasekera1, Paula Ferrada2
1ChristianaCare, 4755 OgletownStanton Rd, Newark, DE, 19718, United States.
American Journal of Surgery
|January 1, 2023
Summary
Managing complex duodenal trauma, a rare but severe injury, requires a multidisciplinary approach due to high complication rates. Current methodologies focus on surgical tenets to improve outcomes for these difficult cases.
Area of Science:
- Trauma Surgery
- Gastrointestinal Surgery
- Surgical Management
Background:
- Complex duodenal trauma is a rare injury, accounting for 1-4.7% of all abdominal trauma.
- Historically, diverse management strategies have been employed for these injuries and their complications.
- This review examines current management methodologies for complex duodenal injuries.
Purpose of the Study:
- To review the current management methodology of complex duodenal injury.
- To synthesize past and current approaches to managing duodenal trauma.
- To highlight the challenges and outcomes associated with complex duodenal trauma.
Main Methods:
- A comprehensive literature review was conducted.
- Searches included Google Scholar and PubMed from 1970-2022.
- Keywords used were: complex duodenal trauma, surgical management, and duodenal complications.
Main Results:
- Complex duodenal trauma is classified as AAST grades III-V.
- Management tenets include damage control, tissue resection, GI continuity restoration, diversion, and feeding access.
- Complication rates are as high as 65%, with abscess, dehiscence, and fistula being common. Mortality ranges from 5-30%.
Conclusions:
- Numerous repair strategies exist, addressing key management tenets.
- High complication risks necessitate a thoughtful, multidisciplinary treatment approach.
- Effective management of complex duodenal injuries remains challenging.
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