Siddique Ahmad, Yousaf Jan, Ihsan-ul Haq.
Management of Duodenal Injuries: Our Experience at a Tertiary Care Hospital.
Ophthalmol Update Jan ;12(4):321-5.

Background: Duodenal injury is an uncommon finding, accounting for about 3-5% of abdominal trauma, mainly resulting from both penetrating and blunt trauma, and is associated with significant mortality (6-25%) and morbidity (30-60%). Objective: The aim of this study was to report our experience with duodenal injuries management and outcome of different procedures performed for both penetrating and blunt duodenal trauma. Material and Methods: This study was conducted in Hayatabad Medical Complex Peshawar, Pakistan from February 2008 to August 2012 after obtaining permission from local research and ethical committee. Fifty five patients who underwent surgery for duodenal injuries were included. Management of duodenal injury was classified as primary repair, tube decompression and more complex procedures like pyloric exclusion and Roux-en-Y duodeno-jejunostomy. Results: During the study period, out of 55 patients, 38 (69%) were injured by penetrating trauma (33 gunshot wounds, 5 stab wounds) and 17 (31%) by blunt trauma. There were 42 males and 13 females with M:F ratio of 3.2:1 as shown in (Table 1). 27 patients (49%) presented in hypovolemic shock. The most common injury site was in the second part of the duodenum (20 of 55, 36.4%). The remaining injuries were distributed anatomically as follows: first part, 16 patients (29%), third part, 13 patients (23.7%) and fourth part, 6 patients (10.9%). None of these wound involve the ampullary complex. Twenty eight patients (50.9%) suffered grade II duodenal injuries, fourteen patients (25.4%) grade 111 duodenal injuries, nine patients (16.4%) grade 1V injuries and four patients (7.3%) had grade 1 injuries respectively. No grade V injury was noted. Out of 55 patients, 8 (14.5%) suffered combined pancreatico-duodenal injuries. Five patients (9%) had duodenal leak with fistula postoperatively, 2 with grade 111 injuries and 2 with grade 1V injuries. Two patients (3.6%) with combined pancreatico-duodenal injuries had pancreatic fistula postoperatively which were managed conservatively. Four patients (7.2%) developed sepsis, of which two were recovered completely. Five patients (9%) died postoperatively, 2 with duodenal leak, 2 with sepsis and one with associated major injuries. Conclusion: The surgical management of duodenal injury is complex but majority of duodenal injuries is suitable for primary repair. Associated organ injuries and delayed presentation to hospital are the main determinants of increased morbidity and mortality in duodenal injury.

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