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How are duodenal trauma managed? A French nationwide study
Sébastien Frey1,2, Imad Bentellis3, Sébastien Gaujoux4
1University Côte d'Azur, Nice, France. freysebastien6@gmail.com.
Background:
Duodenal injuries are rare, associated with a significant morbidity. Their management is challanging and remains controversial.
Methods:
A retrospective study of all consecutive patients with duodenal trauma managed in 21 French trauma centers from 2004 to 2023. Clinical data, trauma mechanisms, injury severity, treatment modalities and outcomes were collected. Specific attention was given to surgical techniques such as damage control laparotomy, primary repair only and duodenal diversion. Statistical analysis was performed to identify factors associated with duodenal leak, severe morbidity and mortality.
Results:
One hundred and thirty-five patients (71.7% male, mean age 35 years) were included, 64% with blunt trauma. Duodenal AAST grades I-II occurred in 68.2% and grades III-V in 31.8%. A discrepancy between radiologic evaluation and intraoperative observations was present in 30.8% of cases, underestimating injury severity in 29.1%. Initial management was nonoperative for 12.7%. Damage control laparotomy was required in 36.6%. Operated patients underwent direct suture (69.2%), duodenal resection (24.4%), duodenal diversion (35.8%). Duodenal leaks occurred in 23.7%, significantly increased by hemodynamic instability (OR = 3.08, p = 0.015) and associated pancreatic trauma (OR = 2.44, p = 0.044). Reoperation rate was 18.5%, for missed duodenal injury (16%) and/or for duodenal leak (32%). Mean length of stay was 27 days. Major morbidity was 27.4% and 30-day mortality 10.4%. The injury severity score was the only predictive factor of major morbidity and mortality.
Conclusions:
Duodenal trauma remains a severe condition managed mostly with primary repair, where duodenal leak-significantly associated with hemodynamic instability and pancreatic injury, is a major driver of reintervention.
Trial Registration:
This study was registered on Clinical Trials under the registration numbe NCT06058975.
Insights
Duodenal trauma is a severe injury. Primary repair is common, but duodenal leaks, often linked to hemodynamic instability and pancreatic injury, frequently lead to reoperation.
Area of Science:
- Trauma Surgery
- Surgical Gastroenterology
- Emergency Medicine
Background:
- Duodenal injuries are rare but associated with significant morbidity.
- Management of duodenal trauma presents challenges and remains controversial.
- This study addresses the complexities of duodenal trauma management.
Purpose of the Study:
- To analyze management strategies and outcomes of duodenal trauma.
- To identify factors associated with duodenal leak, severe morbidity, and mortality.
- To evaluate the effectiveness of different surgical techniques in duodenal trauma care.
Main Methods:
- Retrospective study of 135 patients with duodenal trauma across 21 French trauma centers (2004-2023).
- Data collected on clinical characteristics, trauma mechanisms, injury severity (AAST grades), treatment modalities, and outcomes.
- Statistical analysis to determine predictors of duodenal leak, morbidity, and mortality, focusing on surgical techniques like damage control laparotomy, primary repair, and duodenal diversion.
Main Results:
- 64% of injuries were blunt trauma; 31.8% were severe (AAST grades III-V).
- Radiologic evaluation underestimated injury severity in 29.1% of cases.
- Duodenal leaks occurred in 23.7%, significantly associated with hemodynamic instability and pancreatic trauma. Reoperation rate was 18.5%.
Conclusions:
- Duodenal trauma is a severe condition predominantly managed with primary repair.
- Duodenal leak is a major driver of reintervention, strongly linked to hemodynamic instability and associated pancreatic injury.
- Injury Severity Score is the sole predictor of major morbidity and mortality in duodenal trauma patients.
