Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Treatment Outcomes of Traumatic Duodenal Injury

외상성 십이지장 손상의 치료 성적

  • Yu, Byunghyuk (Department of Surgery, Kyungpook National University, School of Medicine, Trauma Center) ;
  • Cho, Jayun (Department of Surgery, Kyungpook National University, School of Medicine, Trauma Center) ;
  • Lim, Kyoung Hoon (Department of Surgery, Kyungpook National University, School of Medicine, Trauma Center) ;
  • Park, Jinyoung (Department of Surgery, Kyungpook National University, School of Medicine, Trauma Center)
  • 유병혁 (경북대학교 의과대학 외과학교실, 외상센터) ;
  • 조자윤 (경북대학교 의과대학 외과학교실, 외상센터) ;
  • 임경훈 (경북대학교 의과대학 외과학교실, 외상센터) ;
  • 박진영 (경북대학교 의과대학 외과학교실, 외상센터)
  • Received : 2015.07.02
  • Accepted : 2015.10.04
  • Published : 2015.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment. Methods: A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed. Results: Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is $13.6{\pm}9.6$. The mean AIS is $8.9{\pm}6.5$. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%. Conclusion: ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.

Keywords

References

  1. Carrillo EH, Richardson JD, Miller FB. Evolution in the management of duodenal injuries. J Trauma 1996 ;40: 1037-46. https://doi.org/10.1097/00005373-199606000-00035
  2. Jang JJ, Hong SI, Kim HS, Lee JH, Kim HJ, Jeon JY, et al. A clinical study of traumatic duodenal injury. J Korean Surg Soc 2008; 74: 424-8.
  3. Park OH, Park YC, Lee DG, Kim HH, Park CY, Kim JC. Surgical management of duodenal traumatic injuries: A single center study. J Trauma Inj 2013; 26: 157-62.
  4. Lee CY, Kim TS, Yoon KS, Hong KC, Woo ZH. Surgical management of traumatic duodenal injuries. J Korean Surg Soc 1993; 44: 820-27.
  5. Pandey S, Niranjan A, Mishra S, Agrawal T, Singhal BM, Prakash A, et al. Retrospective analysis of duodenal injuries: a comprehensive overview. Saudi J Gastroenterol 2011; 17: 142-4. https://doi.org/10.4103/1319-3767.77247
  6. Velmahos GC1, Constantinou C, Kasotakis G. Safety of repair for severe duodenal injuries. World J Surg 2008; 32: 7-12. https://doi.org/10.1007/s00268-007-9255-4
  7. Adkins RB Jr, Keyser JE III. Recent experiences with duodenal trauma. Am Surg 1985; 51: 121-31.
  8. Degiannis E, Boffard K. Duodenal injuries. Br J Surg 2000; 87: 1473-9. https://doi.org/10.1046/j.1365-2168.2000.01594.x
  9. Sriussadaporn S, Pak-art R, Sriussadaporn S, Kritayakirana K. Management of blunt duodenal injuries. J Med Assoc Thai 2004; 87: 1336-42.
  10. Cho JB, Lee JH, Lee DS. Experiences with pancreaticoduodenal injuries at a single institute. J Trauma Inj 2013; 26: 266-72.
  11. Seamon MJ, Pieri PG, Fisher CA, Gaughan J, Santora TA, Pathak AS, et al. A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? J Trauma 2007; 62: 829-33. https://doi.org/10.1097/TA.0b013e318033a790
  12. DuBose JJ, Inaba K, Teixeira PG, Shiflett A, Putty B, Green DJ, et al. Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank. Am Surg 2008; 74: 925-9.
  13. Girgin S, Gedik E, Yag mur Y, Uysal E, Bac B. Management of duodenal injury: our experience and the value of tube duodenostomy. Ulus Travma Acil Cerrahi Derg 2009; 15: 467-72.
  14. Fang JF, Chen RJ, Lin BC. Surgical treatment and outcome after delayed diagnosis of blunt duodenal injury. Eur J Surg 1999; 165: 133-9. https://doi.org/10.1080/110241599750007315
  15. Rathore MA, Andrabi SI, Najfi SM, Chaudhry Z, Chaudhry AM. Injuries to the duodenum-prognosis correlates with body Injury Severity Score: a prospective study. Int J Surg 2007; 5: 388-93. https://doi.org/10.1016/j.ijsu.2007.05.006
  16. Blocksom JM, Tyburski JG, Sohn RL, Williams M, Harvey E, Steffes CP, et al. Prognostic determinants in duodenal injuries. Am Surg 2004; 70: 248-55.