Siri Chand, Abdul Ghani Shaikh, Quratulain Soomro, Aijaz Ahmed Memon.
Surgical experience regarding management of traumatic duodenal injuries.
Pak J Med Health Sci Jan ;4(3):229-32.

Objective: To share our surgical experience of duodenal injuries in past 6 years and to evaluate different surgical approaches regarding management of duodenal injuries, and to establish relationship between grades of injury and surgical treatment employed and outcome of each. Patients and methods: 32 consecutive patients diagnosed with traumatic duodenal injuries admitted to CMCTH during 6 years period from March 2002 to April 2008 were retrospectively analyzed. The data collected on study specific Performa included demographic data, cause of injury, number and size of injury, anatomic location of duodenal injury, grade of duodenal injury, injuries to surrounding structures, surgical procedures performed, postoperative complications, morbidity and mortality. Results: During the period under study a total of 32 consecutive patients with duodenal injuries were included in the study. There were 29 (90.6%) male and 3 (9.4%) female with male to female ratio of 9:1 and mean age of 27.8 years. 78.12% cases were due to penetrating injuries predominantly firearm injuries and 22.98% were due to blunt trauma. second part of duodenum was found to be the most commonly injured site in 53% case and grade III injuries accounted for 53% of total injuries. The most common operative procedure performed was Primary Repair with and without Tube Duodenostomy. Postoperatively 6.25% cases developed duodenal fistula, and the overall morbidity was found to be 34.37% and mortality 28%. Conclusion: It is concluded that the most commonly duodenal injury were grade III injury manage with successfully primary repair with or without tube Duodenostomy. Therefore it is recommended that primary repair with or without tube duodenostomy can be safely performed upto grade 3 traumatic duodenal injuries, while complex procedure should be reserved for grade IV and V injuries.

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