Complex penetrating duodenal injuries

Ordóñez, Carlos A.; García, Alberto; Parra, Michael W.; Scavo, David; Pino, Luis Fernando; Millán, Mauricio; Badiel, Marisol; Sanjuán, Juan Antonio Garrido; Rodríguez, Fernando; Ferrada, Ricardo; Puyana, Juan Carlos

doi:10.1097/ta.0000000000000214

Cited by 47 publications

(55 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This hiatus is thought to prevent duodenal fistulization, which is the most feared late complication of duodenal injury, seen in 6.6 % of patients [2]. The evidence behind preventing this complication is admittedly mixed, and the purported benefit of pyloric exclusion remains controversial [1,[3][4][5][6].…”

Section: Resultsmentioning

confidence: 96%

Creation of a neopylorus after pyloric exclusion using a “double-endoscope” technique

et al. 2015

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 96%

Creation of a neopylorus after pyloric exclusion using a “double-endoscope” technique

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The treatment of duodenal lesions varies according to the severity of each individual case, and can involve anything from primary closure to a Whipple procedure. 11,12 However, according to Ordonez et al 6 , in more severe cases, mainly those associated with multiple organ injuries & hemodynamic instability (accounting for 25% of deaths -hypovolemic shock) it is recommended to perform damage control surgery briefly in order to put the patient in a better position for definitive treatment. Primary duodenal repair is the main intervention in this study (90.9%), as described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Most injuries are penetrating, with a predominance of FA injuries, corroborating the literature. According to Ordoñez et al, 6 the incidence of duodenal injuries varies between 3 and 5% of laparotomies in trauma. After evaluating 44 patients with penetrating abdominal trauma, most were by FA.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Statistically, duodenal injury occurs in about 3 to 5% of abdominal trauma, and penetrating injuries are responsible for most cases. [3][4][5][6][7] The morbidity and mortality of this type of injury is directly related to diagnostic delay and associated injuries. 1,3 As for the classification of injuries, the American Association for Surgery of Trauma (AAST) guidelines 8 were used and they divide the extent of duodenal trauma into degrees of severity ranging from I to V according to Table 1.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Alcoholic Beverage and Traffic Accidents: Impact of the Drunk-Driving Law in Severity and Mortality of Victims

Nogueira¹,

Domingues²,

Bonfim³

2017

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

View full text Add to dashboard Cite

Rationale: Duodenal injuries are rare and most common due to penetrating abdominal trauma, especially gunshot wounds, with greatest prevalence among young men. Achieving simpler and more effective surgical procedures also contributes to the reduction of mortality and morbidity rates.Objective: Review cases of penetrating and blunt duodenal trauma, the complexity of the injuries, incidence, management as well as morbidity and mortality. Materials and methods:At Grajaú General Hospital, between January 2010 and May 2014, a retrospective analysis of 1,039 patients' medical records who had undergone emergency exploratory laparotomies was done. From these cases, 298 were caused by blunt and penetrating abdominal traumas, and 11 suffered duodenal traumas.Results: It was observed that there was a predominance of young adults (mean age 26.48 years) and all patients were males (100%), of which one injury was from blunt abdominal trauma, three from stab wounds, and seven caused by firearm. Most of the duodenal injuries were classified as grade II injuries and most commonly involved the fourth portion of the duodenum. We emphasize the association with injuries to other organs, especially the liver and the small intestine. In the cases we analyzed, we highlight the importance of time between entry of service and surgery in all patients being less than 6 hours. The most common surgery performed to repair these injuries was duodenorrhaphy (90.9%). In this series, there were four deaths. Postoperative complications included duodenal fistulae with spontaneous resolution.Conclusion: Duodenal injuries are rare, and are most commonly due to penetrating abdominal trauma, especially gunshot wounds, with the greatest prevalence among young men. There is a need for early diagnosis and rapid surgical intervention, shortened and effective surgical procedures, due to the morbidity/mortality and high complexity of these injuries. This emphasizes the importance of early intervention in the short time before surgical procedure takes place.

show abstract

“…Sin embargo, estudios posteriores 20 no han mostrado diferencias significativas respecto a la duodenorrafia en lo que se refiere a tasa de fistulización, por lo que empezó a surgir el concepto de que hacer menos es mejor ("less is better"). 21 En una revisión crítica de tres trabajos enfocados en las indicaciones de la exclusión pilórica 22 publicada en el año 2012, se concluye que la misma debe ser restringida a pacientes muy seleccionados y que el nivel de evidencia sigue siendo bajo tanto para recomendarla como para sugerir que sea abandonada. Esto último se debe al carácter retrospectivo de la mayoría de los trabajos así como al bajo número de pacientes que incluyen, dada la relativa baja frecuencia de estas lesiones.…”

Section: Discusionunclassified

Trauma Duodenal Penetrante: Manejo Quirúrgico

Rodríguez¹,

Trostchansky²,

Chinelli³

et al. 2018

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

View full text Add to dashboard Cite

Introducción: Las lesiones duodenales por trauma penetrante son infrecuentes, y la mayoría corresponde a heridas por arma de fuego. Constituyen un desafío terapéutico y la evidencia actual para recomendar procedimientos de reparación complejos continua siendo escasa.Objetivos: Revisar el manejo quirúrgico de una serie de pacientes con trauma duodenal penetrante asistidos en el Material y métodos: Estudio retrospectivo, observacional y descriptivo. Se incluyeron 16 pacientes, obteniendo los datos de las Historias Clínicas. Las variables principales fueron: tipo de lesión según la clasificación de la AAST-OIS, asociación lesional, tipo de reparación duodenal y falla de la reparación.Resultados: La media de edad fue 25,6 años. 15 pacientes presentaron lesiones tipo II y en 1 fue tipo IV. Todos asociaron otras lesiones intraabdominales. El manejo inicial fue duodenorrafia en todos los casos, requiriendo exclusión duodenal posteriormente en un paciente. En un caso existió falla de la duodenorrafia y fallecieron 5 pacientes (31%).Discusión: La duodenorrafia es el procedimiento de elección para la mayoría de las lesiones duodenales. La evidencia actual aún no es suficiente para recomendar o abandonar el uso de técnicas adyacentes de mayor complejidad para disminuir la tasa de complicaciones de la rafia duodenal.Conclusiones: nuestra serie mostró resultados similares a los descritos en la literatura, con alto porcentaje de resolución mediante una rafia simple, asociación lesional en todos los casos y curva bimodal de mortalidad. ABSTRACTIntroduction: Duodenal injuries from penetrating trauma are infrequent, and most are from gunshot wounds. They constitute a therapeutic challenge and the current evidence for recommending complex repair procedures continues to be scarce. Objectives:To review the surgical management of a series of patients with penetrating duodenal trauma assisted in the Emergency Department of Hospital Maciel in the period 2009 to 2016. Materials and methods:Retrospective, observational, and descriptive study. The study included 16 patients, and obtained data from the clinical histories. The main endpoints were: type of injury according to American Association for the Surgery of Trauma-Organ Injury Scaling classification, lesion association, type of duodenal repair, and repair failure. Results:The mean age was 25.6 years; 15 patients had type II lesions and 1 had type IV lesion. All were associated with other intra-abdominal injuries. The initial management was duodenorrhaphy in all cases, requiring duodenal exclusion later in a patient. In one case there was a failure of duodenorrhaphy and 5 patients died (31%). Discussion:Duodenorrhaphy is the procedure of choice for most duodenal lesions. Current evidence is not yet sufficient to recommend or abandon the use of adjacent techniques of greater complexity to decrease the rate of complications of duodenal repair. Conclusion:Our series showed results similar to those described in the literature, with a high percentage of resolution by simple raphy, associat...

show abstract

Complex penetrating duodenal injuries

Abstract: Therapeutic study, level IV.

Cited by 47 publications

References 17 publications

Creation of a neopylorus after pyloric exclusion using a “double-endoscope” technique

Creation of a neopylorus after pyloric exclusion using a “double-endoscope” technique

Alcoholic Beverage and Traffic Accidents: Impact of the Drunk-Driving Law in Severity and Mortality of Victims

Trauma Duodenal Penetrante: Manejo Quirúrgico

Contact Info

Product

Resources

About