Surgical Management of Duodenal Traumatic Injuries: A Single Center Study

외상성 십이지장 손상의 수술적 치료: 단일 기관 연구

  • Park, Oh Hyun (Division of Trauma, Department of Surgery, Chonnam National University Medical School) ;
  • Park, Yun Chul (Division of Trauma, Department of Surgery, Chonnam National University Medical School) ;
  • Lee, Dong Gyu (Division of Trauma, Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Ho Hyun (Division of Trauma, Department of Surgery, Chonnam National University Medical School) ;
  • Park, Chan Yong (Division of Trauma, Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Jung Chul (Division of Trauma, Department of Surgery, Chonnam National University Medical School)
  • 박오현 (전남대학교 의과대학 외과학교실) ;
  • 박윤철 (전남대학교 의과대학 외과학교실) ;
  • 이동규 (전남대학교 의과대학 외과학교실) ;
  • 김호현 (전남대학교 의과대학 외과학교실) ;
  • 박찬용 (전남대학교 의과대학 외과학교실) ;
  • 김정철 (전남대학교 의과대학 외과학교실)
  • Received : 2013.05.15
  • Accepted : 2013.09.02
  • Published : 2013.09.30

Abstract

Purpose: Abdominal trauma rarely causes injuries involving duodenum. But, it is associated with higher rate of the complication and mortality than other abdominal injuries. There are many options for the management of duodenal injuries. Herein we are to review our experiences and find out the risk factors related to the morbidity and the mortality in traumatic duodenal injuries. Methods: The medical records of total 25 patients who managed by surgical managements and survive more than 48 hours were conducted from January 2006 to December 2012. The clinical characteristics, treatments, and outcomes are reviewed. Results: Among 25 patients, most of them (n=17, 68.0%) were managed by the pyloric exclusion and the gastrojejunostomy. The $3^{rd}$ portion is the most injured site (n=15, 60.0%), and the majority exhibited grade 2 severity (n=14, 56.0%). Most of patients had blunt abdominal traumas (n=23, 92.0%) so that many of them (n=14, 56.0%) had other combined abdominal injuries. The mean ISS is $11.5{\pm}6.2$. The surgery related mortality rate was 28.0%. There was no statistical significance between each factors and the mortality except leakage (p=0.012). But, we could find some trends about traumatic duodenal injuries in this study. The mortality rates of them who older than 55 years were higher than others. And, all 3 patients who delayed the operation more than 24 hours after the trauma had some complications or died. Also, the patients who had the $2^{nd}$ portion injury, grade 3 injury, or combined abdominal injury were less survived. Conclusion: Duodenal injury is related to high rate of morbidity(47.8%) and mortality(28.0%). Age, portion of injury, OIS grade, ISS>15, combined intra-abdominal operation, and trauma to operation time over 24 hrs have some trend with attribution to mortality. Especially leakage of duodenal injury is related to mortality.

Keywords

References

  1. Timaran CH, Martinez O, Ospina JA. Prognostic factors and management of civilian penetration duodenal trauma. J Trauma 1999; 47: 330-5. https://doi.org/10.1097/00005373-199908000-00019
  2. Degiannis E, Boffard K. Duodenal injuries. Br J Surg 2000; 87: 1473-9 https://doi.org/10.1046/j.1365-2168.2000.01594.x
  3. Acosta J. Management of specific injuries, injuries to the duodenum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Saunders-Elsevier; 2008. P.505-6
  4. Velmahos GC, Constantinou C, Kasotakis G. Safety of repair for severe duodenal injuries World J Surg. 2008; 32(1): 7-12. https://doi.org/10.1007/s00268-007-9255-4
  5. 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(4): 829-33. https://doi.org/10.1097/TA.0b013e318033a790
  6. Sharma AK. Management of pancreaticoduodenal injuries. Indian J Surg. 2012; 74(1): 35-9. https://doi.org/10.1007/s12262-011-0386-3
  7. Blocksom JM, Tyburski JG, Sohn RL, Williams M, Harvey E, Steffes CP, et al. Prognostic determinants in duodenal injuries. Am Surg. 2004; 70(3): 248-55.
  8. Sriussadaporn S, Pak-art R, Sriussadaporn S, Kritayakirana K. Management of blunt duodenal injuries. J Med Assoc Thai. 2004; 87(11): 1336-42.
  9. 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(2): 142-4. https://doi.org/10.4103/1319-3767.77247
  10. Adkins RB Jr, Keyser JE 3rd. Recent experiences with duodenal trauma. Am Surg. 1985; 51(3): 121-31.
  11. Carrillo EH, Richardson JD, Miller FB. Evolution in the management of duodenal injuries. J Trauma. 1996; 40(6): 1037-45. https://doi.org/10.1097/00005373-199606000-00035
  12. Kim HC, Shin HC, Park SJ, Park SI, Kim HH, Bae WK, et al. Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident. Clin Imaging. 2004; 28(5): 334-9. https://doi.org/10.1016/S0899-7071(03)00244-4
  13. Fraga GP, Biazotto G, Bortoto JB, Andreollo NA, Mantovani M. The use of pyloric exclusion for treating duodenal trauma: case series. Sao Paulo Med J. 2008; 126(6): 337-41.
  14. Fang JF, Chen RJ, Lin BC. Controlled reopen suture technique for pyloric exclusion. J Trauma. 1998; 45(3): 593-6. https://doi.org/10.1097/00005373-199809000-00032
  15. Sriussadaporn S, Pak-art R, Sriussadaporn S, Kritayakirana K. Management of blunt duodenal injuries. J Med Assoc Thai. 2004; 87(11): 1336-42.
  16. Stawicki SP, Schwab CW. Pancreatic trauma: demographics, diagnosis, and management. Am Surg. 2008; 74(12): 1133-45.
  17. Wig JD, Kudari A, Yadav TD, Doley RP, Bharathy KG, Kalra N. Pancreas preserving total duodenectomy for complex duodenal injury. JOP. 2009; 10(4): 425-8.
  18. Asensio JA, Petrone P, Rold?n G, Kuncir E, Demetriades D. Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries. J Am Coll Surg. 2003; 197(6): 937-42. https://doi.org/10.1016/j.jamcollsurg.2003.07.019
  19. Lee KJ, Kwon J, Kim J, Jung K. Management of blunt pancreatic injury by applying the principles of damage control surgery: experience at a single institution. Hepatogastroenterology. 2012; 59(118): 1970-5.
  20. Brenner M, Bochicchio G, Bochicchio K, Ilahi O, Rodriguez E, Henry S, et al. Long-term impact of damage control laparotomy: a prospective study. Arch Surg. 2011; 146(4): 395-9. https://doi.org/10.1001/archsurg.2010.284