Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST [American Association for Surgery of Trauma]. 17/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Primary repair is sufficient for most non-resectional duodenal injuries

prospective reappraisal of duodenal injuries: Correlation of outcome with organ injury severity [OIS]

A study of 20 consecutive patients with duodenal injuries admitted in a Surgical Unit of Mayo Hospital, Lahore in the year 1993 - 95 is presented. Majority of patients were young [mean age 28.5 years] male [90%]. Penetrating injuries [80%] were far more common than blunt trauma. According to organ injury scale [OIS], eight patients had Grade I and II injuries, twelve had Grade III and IVinjuries. Eighty five percent of patients had associated injuries to other organs. Primary duodenal repair [60%], duodenal repair with gastro jejunostomy [30%], resection of duodenum with duodenojejunal end to end anastomosis [5%], and pyloric exclusion with gastro jejunostomy [5%] were the procedures carried out. Morbidity in this series was 85% and mortality 20%