Complete transection of third part of duodenum following blunt injury abdomen: a rare case report

Blunt injury abdomen (BIA) is an ever-increasing problem. Isolated injury to duodenum following BIA is rare (1-4%). It can be a challenge to the surgeon and failure to manage it properly can lead on to devastating results. Blunt duodenal injury can occur in isolation or with pancreatic injury. We report a case of an isolated transection of third part of the duodenum following BIA. Initial clinical changes in isolated duodenal injury may be subtle before life-threatening peritonitis develops. High index of suspicion, knowledge of mechanism of injury, physical examination and proper imaging techniques are the key in early detection of duodenal injury.

Application of double-tube gastrostomy in the repair of duodenal rupture / 中华消化外科杂志

Objective To investigate the application value of double-tube gastrostomy in the duodenal rupture repair.Methods The retrospective cohort study was adopted.The clinical data of 41 patients who underwent duodenal rupture repair at the Chongqing Emergency Medical Center from January 2005 to January 2015 were collected.Twenty-five patients using Hassan triple-tube gastrostomy technique between January 2005 and December 2009 were divided into the triple-tube (TT) group and 16 patients using double-tube gastrostomy technique between January 2010 and January 2015 were divided into the double-tube (DT) group.Duodenal rupture repair included suture repair,pedicled ileal flap to repair duodenal defect and end to end anastomosis.Patients underwent the regular treatments of anti-infection,antishock,somatostatin inhibition,nutritional support and complications prevention.Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation,and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube.The postoperative complications (duodenal fistula,intraperitoneal infection,incision infection,pulmonary infection and intestinal obstruction),operation method,operation time,volume of blood loss,euteral nutritional tube removal time and duration of hospital stay were observed.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using an independent sample t test.Comparison of count data was analyzed using chi-square test or Fisher exact probability.Results All the 41 patients underwent duodenal rupture repair,including 28 using suture repair of duodenal rupture,8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis,with the intraoperative duodenal decompression and placement of intestinal feeding tube.The operation time was (184 ± 38)minutes in the TT group and (153 ± 37)minutes in the DT group,with a significant difference between the 2 groups (t =2.566,P ＜0.05).The volume of intraoperative blood loss was (1 112 ± 707)mL in the TT group and (1 011 ± 595)mL in the DT group,with no significant difference between the 2 groups (t =0.476,P ＞ 0.05).The proportions of duodenal fistula,intraperitoneal infection,incision infection and pulmonary infection in the TT and DT groups were 3/25 and 1/16,8/25 and 5/16,9/25 and 4/16,10/25 and 6/16,respectively,showing no significant difference between the 2 groups (x2=0.003,0.545,0.026,P ＞ 0.05).Eleven patients were complicated with postoperative early intestinal obstruction,including 10 (3 with partial duodenal stenosis and 7 with incomplete small intestinal obstruction) in the TT group and 1 (partial duodenal stenosis) in the DT group,showing a significant difference in the incidence of postoperative early intestinal obstruction between the 2 groups (P ＜ 0.05).Patients with early intestinal obstruction had remission after conservative treatment of gastrointestinal decompression and fasting.The time of intestinal feeding tube indwelling and duration of hospital stay were (25 ±9)days and (29 ± 9)days in the TT group,(19 ± 9)days and (23 ± 8) days in the DT group,with significant differences between the 2 groups (t =2.188,2.120,P ＜ 0.05).Conclusion Double-tube gastrostomy technique for duodenal rupture repair can simplify the operation procedures and reduce operation time,recovery time and risk of postoperative intestinal obstruction,with a reliable efficacy.

Duodenal Injury after Blunt Abdominal Trauma: Report of Two Cases

Duodenal injuries following a blunt or penetrating trauma are uncommon and account for just 3% to 5% of all abdominal injuries. About 22% of all duodenal injuries are caused by blunt trauma. An overlooked injury or delayed diagnosis of duodenal injury may lead to increased mortality and morbidity. We report two cases of a duodenal injury following blunt abdominal trauma.

Blunt abdominal injury in suspected child abuse patients: A three-case report.

Objective: To identify characteristics associated with suspected child abuse in the setting of blunt abdominal trauma. Methods: Retrospective review. Results: Three cases of blunt abdominal injury caused by suspected abusive force admitted in Siriraj Hospital between May 2001 and July 2006 are reviewed. The first case is a six-year old boy who had liver laceration grade III at segment II and III. The history of trauma was refused by his parents initially. At last, the patient confessed that he was hit by the mother’s boy friend. The second case is a-10-month old girl who was operated for traumatic rupture in the 3rd part of the duodenum (90% circumference) as well as hematoma at the root of mesentery and ligament of Trietz following shopping with her family without history of traumatic event. Chest X-ray showed multiple old fractures at left posterior 6th, 7th, 8th ribs as well as a callus formation at the costochondral junction of the right 7th rib. Bone survey also demonstrated laminated periosteal reaction of the right tibia from previous fracture. The third case is a 3-year-old boy with intramural duodenal hematoma located between the 2nd part of the duodenum and the D-J junction. The patient told that he was stepped upon during lying down by his grandmother who has abused him many times before. Conclusion: Child abuse is suspected in a case of conflict between physical examination findings and history of the accidental events, especially physically damage than the mechanism of injury. The patterns of inflicted injury are also discussed in this publication. Injury to the duodenum is unusual in the pediatric trauma patients but more commonly is the result of child abuse. Diagnosis and treatments of various types of duodenal injury including intramural duodenal hematoma are elucidated in this article.

Multilevel Duodenal Injury after Blunt Trauma

Duodenal trauma is an uncommon injury associated with significant mortality and morbidity. Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains as the ultimate diagnostic test if a high suspicion of duodenal injury continues even in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair of the injured site. More complicated injuries require more sophisticated techniques. Here, we report a case of multilevel blunt duodenal injury successfully managed with duodenal diverticulization, Roux-en-Y gastrojejunostomy and catheter duodenostomy.

A Clinical Study of Traumatic Duodenal Injury

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.

A Clinical Study of Traumatic Duodenal Injury

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.

The duodenal after the traumatic operation and the duodenal injuries: the clinical characteristics and attitude of management

Background: Duodenal fistula is severe complication and complicated in management. Morbidity and mortality were high. The aims of study were to determine the clinical characteristic of duodenal fistula after surgical treatment of duodenal blunt and penetrating trauma, and attitude of treatment. Methodology: Retrospective study was done. Data of the patients with post-operative duodenal fistula after surgical procedure who were admitted in Cho Ray Hospital from 6-1996 to 6-2000 were analyzed. Results: There were 15 posttraumatic duodenal fistulas. Locations of fistula were often in D2 and D3 (80% of cases). Time of appearance of fistula was 10,257,25 days (2-29 days) after operative management of duodenal trauma. Mean of fistula output was 573626ml/24 hours. Total of energy of parenteral nutrition was 800130,23 Kcalo. Post-operative mortality was 26%. Only one case or 6.7% was spontaneous closure with medical treatment. 67.3% of cases was healed by surgical treatment. Conclusion: Main treatment for post-operative fistula of duodenal trauma is surgical procedure. Need of selection of appropriate time for operation is proposed. Pre- and post-operative management such as withholding oral taking, replacing fluid and electrolytes, and administering total parenteral should be paid attention

Early Diagnosis aed Treatment of Duodenal Trauma: A Report of 36 Cases / 中国医师杂志

Objective To explore the early diagnosis and operative treatment of duodenal injury. Methods The clinic data of 36 patients with duodenal trauma were retrospectively analyzed. Results Among 36 cases of duodenal injury, 4 cases (4/36,10.3%) were located in the first section of duodenum, 26 cases (26/36,72.2%) were between the second and third sections of duodenum, 6 cases (6/36,16.7%) were located in the fourth section of duodenum, and 14 cases were accompanied by other organ injury. The frequency of the postoperative complications was 13.9%, the curative rate was 94.4%, and the mortality was 2.8%. Conclusion Familiarizing with charateristics of duodenum injury, early diagnosing, mastering surgical exploration indication, selecting suitable operative approach, effective duodenal decompression, sufficient drainage and anti-infection treatment can improve the curative rate of duodenal injury.

Advance in diagnosis and management of closing duodenal injury / 中国普通外科杂志

Objective To improve the diagnosis and treatment effect of closing duodenal injury. Methods By reviewing the documents, the development in the diagnosis and treatment of duodenal injury were summarized. Results (1) Every patient with closing belly injury should be considered the possibility of duodenal injury; (2) According to the extent of duodenal injury, five common different operetion treatments wuld be adopted respectively; (3) Non-operation treatment should be given to those unable to be operated on, such methods as nutrition support, application of sandostatine etc. Conclusions Combine the operation treatment with the non-operation treatment can greatly improve the cure rate of the duodenal injury.