Diagnosis and treatment of duodenal trauma / 中华消化外科杂志

ABSTRACT

Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with pancreaticoduodenal fistula were cured by conservative treatment at postoperative month 3 and the other patients were well survived.Conclusions Abdominal puncture and imaging examination such as CT are effective methods for the diagnosis of the duodenal injury.Surgical procedure selection should be based on the type and range of the injury.Effective duodenal decompression and complete peritoneal drainage are important for the success of surgery.