How are duodenal trauma managed? A French nationwide study.

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.