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Aceves-Ayala JM, Noriega-Velásquez AJ, Briceño-Fuentes A, Ortiz-Orozco CA, Rojas-Solís PF, Rivas-Quezada PX, Bautista-López CA. Delayed Primary Repair of Complex Duodenal Injury Associated to Multiorgan Failure Due to Blunt Abdominal Trauma. Surg J (N Y) 2023; 9:e92-e96. [PMID: 37700824 PMCID: PMC10495225 DOI: 10.1055/s-0043-1774404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Duodenal injuries are rare and difficult to diagnose, with an incidence between 1 and 5% in cases of abdominal trauma. We present the case of a 30-year-old man who suffered a motorcycle collision presented with a 24-hour history of abdominal pain, peritoneal tenderness, and hemodynamic instability. Imaging studies show evidence of free fluid in the perihepatic, perisplenic, and pelvic space. An exploratory laparotomy was performed, finding a grade III duodenal, grade V jejunal, and grade II pancreatic injuries. The basis of surgical treatment being a primary anastomosis of duodenal and jejunal injuries, which allowed discharging him home 8 days after surgery and without any complications in his follow-up.
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Affiliation(s)
| | | | - Alberto Briceño-Fuentes
- Surgery Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, México
- Department of Surgical Clinics, CUCS, University of Guadalajara, Guadalajara, México
| | | | | | | | - Carlos Alfredo Bautista-López
- Surgery Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, México
- Department of Surgical Clinics, CUCS, University of Guadalajara, Guadalajara, México
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Karveli E, Gogoulou I, Patsaouras PA, Papamichail M, Ioannides C. Triple Tube Drainage for the Treatment of Complex Duodenal Injury: A Case Report and Literature Update. Cureus 2023; 15:e39995. [PMID: 37416037 PMCID: PMC10321675 DOI: 10.7759/cureus.39995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Duodenal trauma resulting in perforation is rare and management can be challenging due to injuries in other organs and vascular structures. Primary repair is the preferred option and is technically feasible even in cases with large defects. In more complex injuries with pancreaticobiliary tract involvement, damage control techniques and staged procedures may be required. Triple tube drainage with tube gastrostomy, tube duodenostomy, and feeding jejunostomy can benefit the adequate decompression of the duodenum and protect the primary repair suture line. We report the case of a 35-year-old male patient with perforation in the second part of the duodenum following a gunshot injury, who was managed with primary repair and triple tube drainage.
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Gao J, Li H, Yang J, Wang J, Ai T, He P, Wei G, Xiang Z, Zhao S. Surgical management of duodenal injury: experience from 92 cases. Eur J Trauma Emerg Surg 2023; 49:1367-1374. [PMID: 36763155 DOI: 10.1007/s00068-023-02238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
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.
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Affiliation(s)
- Jinmou Gao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China.
| | - Hui Li
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jun Yang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jianbai Wang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Tao Ai
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Ping He
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Gongbin Wei
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Zhen Xiang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Shanhong Zhao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
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García A, Sanchez AI, Ferrada P, Wolfe L, Duchesne J, Fraga GP, Benjamin E, Campbell A, Morales C, Pereira BM, Ribeiro M, Quiodettis M, Peck G, Salamea JC, Kruger VF, Ivatury R, Scalea T. Risk factors for the leakage of the repair of duodenal wounds: a secondary analysis of the Panamerican Trauma Society multicenter retrospective review. World J Emerg Surg 2023; 18:28. [PMID: 37016441 PMCID: PMC10074841 DOI: 10.1186/s13017-023-00494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023] Open
Affiliation(s)
- Alberto García
- Division of Trauma and Acute Care Surgery, Department of Surgery, Department of Intensive Care, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
- Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia.
- Department of Surgery, Universidad Icesi, Cali, Colombia.
| | - Alvaro I Sanchez
- Division of Thoracic Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Paula Ferrada
- Division of Trauma and Acute Care Surgery, Innova Fairfax Hospital, Falls Church, VA, USA
| | - Luke Wolfe
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Duchesne
- Department of Surgery, Tulane University, LA, New Orleans, USA
| | - Gustavo P Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | | | - Andre Campbell
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Carlos Morales
- Department of Surgery, Universidad de Antioquia, Medellín, Colombia
| | - Bruno M Pereira
- University of Vassouras, Rio De Janeiro, Brazil
- Santa Casa de Campinas, Campinas, Brazil
| | - Marcelo Ribeiro
- Consultant General and Trauma Surgeon, Chair Division of Trauma, Burns, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Martha Quiodettis
- Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
| | - Gregory Peck
- Department of Surgery, Robert Wood Johnson Place, New Brunswick, NJ, USA
| | - Juan C Salamea
- Department of Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Vitor F Kruger
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Rao Ivatury
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Scalea
- Department of Surgery, Shock Trauma Center, University of Maryland, MD, College Park, USA
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Kadkhodayan K, Hussain A, Khan H, Arain M, Yang D, Hasan MK. Endoscopic pyloric exclusion-EUS-guided gastrojejunostomy combined with endoscopic suturing and closure of the pylorus: a novel approach to failed surgical repair of a perforated duodenal ulcer. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:121-123. [PMID: 36935813 PMCID: PMC10020376 DOI: 10.1016/j.vgie.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Video 1Endoscopic pyloric exclusion: same-session EUS-guided gastro-jejunostomy combined with endoscopic suturing and closure of the pylorus.
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Affiliation(s)
| | - Azhar Hussain
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Hafiz Khan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Mustafa Arain
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida
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Duodenal Injuries. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Bagaria D, Agarwal H, Jaiswal A, Katiyar A, Pandey S, Choudhary N, Alam J, Mishra B, Sagar S, Kumar S, Gupta A. "Repair by Primary Closure of Traumatic Blunt Duodenal Injuries: Simple is Not Always Safe". J Surg Res 2022; 280:50-54. [PMID: 35961257 DOI: 10.1016/j.jss.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Recent literature on managing traumatic duodenal injuries suggests the superiority of primary repair. We hypothesized that duodenal trauma repair by primary closure might not be a safe strategy in an environment dealing predominantly blunt injuries with limited resources. METHODS Data analysis was done from the prospectively maintained trauma registry. The study period chosen was from January 1, 2014 to December 31, 2018. Data of 63 patients were analyzed for demographics, injuries, management, and outcome. Logistic regression was used to identify mortality predictors. RESULTS The most common mechanism of injury was blunt (56/63, 88.9%). Forty (63.5%) patients had associated intraabdominal injuries. The most common American Association for the Surgery of Trauma grade of injury to the duodenum was three in 21 patients. Univariate analysis showed that mortality was associated with hypotension on presentation, higher duodenal grade, associated abdominal vascular injuries, primary closure, and duodenal leak. Logistic regression showed associated associated abdominal vascular injuries, primary closure, and leak remained significant predictors of mortality. CONCLUSIONS Primary repair was found to be an independent predictor of mortality. A patient's physiology is a critical determinant of the outcome. Liberal use of tube duodenostomy over primary repair seems reasonable for blunt duodenal injury management.
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Affiliation(s)
- Dinesh Bagaria
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Harshit Agarwal
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Jaiswal
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Katiyar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Choudhary
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Junaid Alam
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
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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 (KAUNAS, LITHUANIA) 2022; 58:medicina58060801. [PMID: 35744064 PMCID: PMC9229050 DOI: 10.3390/medicina58060801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Traumatic duodenal injury is a rare disease with limited evidence. We aimed to evaluate the risk factors for postoperative leakage and outcomes of pyloric exclusion after duodenal grade 2 and 3 injury. Materials and Methods: We reviewed a prospectively collected trauma database for the period January 2004-December 2020. Patients with grade 2 and 3 traumatic duodenal injury were included. To identify the risk factors for postoperative leakage, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) logistic model. We constructed a receiver operator characteristic (ROC) curve to predict risk factors for postoperative leakage. Results: During the 17-year period, 179,887 trauma patients were admitted to a regional trauma center in Korea. Of these patients, 74 (0.04%) had duodenal injuries. A total of 49 consecutive patients had grade 2 and 3 traumatic duodenal injuries and underwent laparotomy. The incidence of postoperative leakage was 32.6% (16/49). Overall mortality was 18.4% (9/49). A stepwise multivariable logistic regression and LASSO logistic regression model showed that time from injury to initial operation was the sole statistically significant risk factor. The ROC curve at the optimal threshold of 15.77 h showed the following: area under ROC curve, 0.782; sensitivity, 68.8%; specificity, 87.9%; positive predictive value, 73.3%; and negative predictive value, 85.3%. There was no significant difference in outcomes between primary repair alone and pyloric exclusion. Conclusions: Time from injury to initial operation may be the sole significant risk factor for postoperative duodenal leakage. Pyloric exclusion may not be able to prevent postoperative leakage.
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Diggs LP, Gregory S, Choron RL. Review of Traumatic Duodenal Injuries: Etiology, Diagnosis, and Management. Am Surg 2022:31348211065091. [DOI: 10.1177/00031348211065091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traumatic duodenal injuries are rare and often challenging to diagnose and treat. Management of these injuries remains controversial and continues to evolve. Here, we performed a review of the literature and guidelines for the diagnosis and management of traumatic duodenal injuries. A common recommendation in more recent literature is primary, tension-free repair of duodenal injuries when possible if surgical repair is necessary. Conversely, if duodenal injuries are unamenable to primary repair, more complex procedures such as Roux-en-Y duodenojejunostomy or pancreaticoduodenectomy may be necessary. Regardless of injury grade or type of surgical repair, the literature continues to support wide extraluminal drainage. Over time, the management of complex duodenal injuries has evolved to favor simple primary repair whenever possible. According to recent studies, more complex procedures are associated with higher rates of post-operative complications and should be reserved for severe injuries when primary repair is not possible.
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Affiliation(s)
- Laurence P. Diggs
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Stephanie Gregory
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Rachel L. Choron
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Lai CC, Huang HC, Chen RJ. Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review. BMC Surg 2020; 20:217. [PMID: 33008373 PMCID: PMC7532557 DOI: 10.1186/s12893-020-00882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
Background Gastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify. Case presentation A young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass. Conclusions Assessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival.
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Affiliation(s)
- Chun-Chi Lai
- Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan.
| | - Hung-Chang Huang
- Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Ray-Jade Chen
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
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