Top

European Journal of Trauma and Emergency Surgery

Published in:

10-02-2023 | Laparotomy | Original Article

Surgical management of duodenal injury: experience from 92 cases

Authors: Jinmou Gao, Hui Li, Jun Yang, Jianbai Wang, Tao Ai, Ping He, Gongbin Wei, Zhen Xiang, Shanhong Zhao

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

Abstract

Purpose

Duodenal injury increases with traffic accidents, and delayed diagnosis or inappropriate operation increase mortality and complications. This study aimed to explore early recognition and timely surgical intervention.

Methods

All patients with duodenal injuries treated operatively during the past 10 years were reviewed, and the data were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome.

Results

A total of 92 patients with duodenal injuries accounted for 7.3% of 1258 patients with abdominal injury. Of the 92 patients, 71 (77.17%) experienced blunt trauma, with traffic accidents accounting for 59.2% (42/71). In 35 patients, a preoperative diagnosis was obtained by reviewing abdominal signs, peritoneocentesis, and imaging. The remaining 57 patients underwent urgent laparotomy, through which a definitive diagnosis of duodenal injury was confirmed during the operation. In all 92 patients, the surgical procedures involved simple sutures; pedicled jejunal piece coverings; and various anastomoses following resection of the injured duodenal portion, including the Whipple procedure and damage-control surgery principles. The overall mortality rate was 12.0% (11/92) with deaths mainly occurring due to associated injuries. When excluding 2 cases of intraoperative death, there were 47 cases in the double-tube gastrostomy group and 43 cases in the traditional triple-tube group, with mortality rates of 10.64% and 9.30% in the two groups, respectively (χ² = 0.045, P > 0.05). Postoperative complications occurred in 15 patients (18.5%). There was a high incidence of duodenal (or pancreatic/biliary) leakage.

Conclusion

Early diagnosis and operation of duodenal injury are crucial to reducing complications and mortality. Surgical methods should be based on injury grade, associated injuries, and vital signs. Double-tube gastrostomy can reduce complications such as intestinal obstruction.

Malhotra A, Biffl WL, Moore EE, Schreiber M, Albrecht RA, Cohen M, et al. Western trauma association critical decisions in trauma: diagnosis and management of duodenal injuries. J Trauma Acute Care Surg. 2015;79:1096–101. https://doi.org/10.1097/TA.0000000000000870.CrossRefPubMed

An extraordinary case of isolated duodenal injury after blunt abdominal trauma. J Coll Physicians Surg Pak. 2022;32:522–4. DOI: https://doi.org/10.29271/jcpsp.2022.04.522.

Park YC, Kim HS, Kim DW, Kang WS, Jo YG, Jang H, et al. Time from injury to initial operation may be the sole risk factor for postoperative leakage in AAST-OIS 2 and 3 traumatic duodenal injury: a retrospective cohort study. Medicina. 2022;58:801. https://doi.org/10.3390/medicina58060801.CrossRefPubMedPubMedCentral

Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg. 2019;14:56. https://doi.org/10.1186/s13017-019-0278-6.CrossRefPubMedPubMedCentral

Phillips B, Turco L, McDonald D, Mause A, Walters RW. Penetrating injuries to the duodenum: an analysis of 879 patients from the National Trauma Data Bank, 2010 to 2014. J Trauma Acute Care Surg. 2017;83:810–7. https://doi.org/10.1097/TA.0000000000001604.CrossRefPubMed

Khan MA, Garner J, Kelty C. Management of duodenal injuries. Trauma. 2012;14:3–15. https://doi.org/10.1177/1460408611412316.CrossRef

Melamud K, LeBedis CA, Soto JA. Imaging of pancreatic and duodenal trauma. Radiol Clin North Am. 2015;53:757–71. https://doi.org/10.1016/j.rcl.2015.02.009.CrossRefPubMed

Poyrazoglu Y, Duman K, Harlak A. Review of pancreaticoduodenal trauma with a case report. Indian J Surg. 2016;78:209–13. https://doi.org/10.1007/s12262-016-1479-9.CrossRefPubMedPubMedCentral

Gosangi B, Rocha TC, Duran-Mendicuti A. Imaging spectrum of duodenal emergencies. Radiographics. 2020;40:1441–57. https://doi.org/10.1148/rg.2020200045.CrossRefPubMed

10.

Schroeppel TJ, Saleem K, Sharpe JP, Magnotti LJ, Weinberg JA, Fischer PE, et al. Penetrating duodenal trauma: a 19-year experience. J Trauma Acute Care Surg. 2016;80:461–5. https://doi.org/10.1097/TA.0000000000000934.CrossRefPubMed

11.

O’Reilly DA, Bouamra O, Kausar A, Malde DJ, Dickson EJ, Lecky F. The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989–2013. Ann R Coll Surg Engl. 2015;97:125–30. https://doi.org/10.1308/003588414X14055925060712.CrossRefPubMedPubMedCentral

12.

Bradley M, Bonds B, Dreizin D, Colton K, Shanmuganathan K, Scalea TM, et al. Indirect signs of blunt duodenal injury on computed tomography: Is non-operative management safe? Injury. 2016;47:53–8. https://doi.org/10.1016/j.injury.2015.10.003.CrossRefPubMed

13.

Butano V, Napolitano MA, Pat V, Wahrenbrock T, Lin P, Quintana MT, et al. Contemporary management of traumatic duodenal injuries. Am Surg. 2021. https://doi.org/10.1177/0003134821995054.CrossRefPubMed

14.

Weale RD, Kong VY, Bekker W, Bruce JL, Oosthuizen GV, Laing GL, et al. Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa. Scand J Surg. 2019;108:280–4. https://doi.org/10.1177/1457496918822620.CrossRefPubMed

15.

Antón J. Management of duodenal trauma. J Trauma Acute Care Surg. 2019;87:739. https://doi.org/10.1097/TA.0000000000002299.CrossRefPubMed

16.

Ferrada P, Wolfe L, Duchesne J, Fraga GP, Benjamin E, Alvarez A, et al. Management of duodenal trauma: a retrospective review from the panamerican trauma society. J Trauma Acute Care Surg. 2019;86:392–6. https://doi.org/10.1097/TA.0000000000002157.CrossRefPubMed

17.

Aiolfi A, Matsushima K, Chang G, Bardes J, Strumwasser A, Lam L, et al. Surgical trends in the management of duodenal injury. J Gastrointest Surg. 2019;23:264–9. https://doi.org/10.1007/s11605-018-3964-x.CrossRefPubMed

18.

Grigorian A, Dosch AR, Delaplain PT, Imagawa D, Jutric Z, Wolf RF, et al. The modern trauma pancreaticoduodenectomy for penetrating trauma: a propensity-matched analysis. Updates Surg. 2021;73:711–8. https://doi.org/10.1007/s13304-020-00855-x.CrossRefPubMed

19.

Turan U, Kilavuz H. Surgical management of penetrating duodenal injury: role of primary repair. J Coll Physicians Surg Pak. 2020;30:1078–81. https://doi.org/10.29271/jcpsp.2020.10.1078.CrossRefPubMed

20.

Krige JE, Kotze UK, Setshedi M, Nicol AJ, Navsaria PH. Surgical management and outcomes of combined pancreaticoduodenal injuries: analysis of 75 consecutive cases. J Am Coll Surg. 2016;222:737–49. https://doi.org/10.1016/j.jamcollsurg.2016.02.005.CrossRefPubMed

21.

de Carvalho MEAJ, Cunha AG. Pancreaticodudonectomy in trauma: one or two stages? Injury. 2020;51:592–6. https://doi.org/10.1016/j.injury.2020.01.018.CrossRefPubMed

22.

Ferrada P. Reply to letter: management of devastating duodenal injuries. J Trauma Acute Care Surg. 2019;87:739–40. https://doi.org/10.1097/TA.0000000000002362.CrossRefPubMed

23.

Dickerson RN, Voss JR, Schroeppel TJ, Maish GO, Magnotti LJ, Minard G, et al. Feasibility of jejunal enteral nutrition for patients with severe duodenal injuries. Nutrition. 2016;32:309–14. https://doi.org/10.1016/j.nut.2015.08.026.CrossRefPubMed

24.

Tao Ai, Gao Jin-mou Hu, Ping ZS, Ma Yu, Fachun Z. Application of double-tube gastrostomy in the repair of duodenal rupture. Chin J Dig Surg. 2016;15:5. https://doi.org/10.3760/cma.j.issn.1673-9752.2016.03.011.CrossRef

25.

Eid AI, Mueller P, Thabet A, Castillo CFD, Fagenholz P. A step-up approach to infected abdominal fluid collections: not just for pancreatitis. Surg Infect. 2020;21:54–61. https://doi.org/10.1089/sur.2019.056.CrossRef

Title: Surgical management of duodenal injury: experience from 92 cases
Authors: Jinmou Gao
Hui Li
Jun Yang
Jianbai Wang
Tao Ai
Ping He
Gongbin Wei
Zhen Xiang
Shanhong Zhao
Publication date: 10-02-2023
Publisher: Springer Berlin Heidelberg
Keywords: Laparotomy
Laparotomy
Gastrostomy
Nutrition
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-023-02238-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical management of duodenal injury: experience from 92 cases

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2023

Intercontinental validation of a clinical prediction model for predicting 90-day and 2-year mortality in an Israeli cohort of 2033 patients with a femoral neck fracture aged 65 or above

Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients

Nanoscopy and an extended lateral approach can improve the management of latero-central segments in tibial plateau fractures: a cadaveric study

Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients

Syringic acid ameliorates ischemia/reperfusion-induced testicular injury in rats via suppressing of HMGB1/NF-κB axis and endoplasmic reticulum stress

Inter-rater reliability of the Abbreviated Injury Scale scores in patients with severe head injury shows good inter-rater agreement but variability between countries. An inter-country comparison study