Modified pyloric exclusion for infants with complex duodenal injuries

Harting, Matthew T.; Doherty, Debra; Lally, Kevin P.; Andrews, William; Cox, Charles S.

doi:10.1007/s00383-005-1457-y

Cited by 4 publications

(3 citation statements)

References 13 publications

(24 reference statements)

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“…Given the close relationship between duodenal and pancreatic trauma, and the known association between pancreatic trauma and local complications, the availability of this information would have served to augment our investigation. Secondly, our study design excluded pediatric patients [28][29][30] and those undergoing operation in a delayed fashion. 31 The role of PEX in these settings may prove very different than in our chosen study population.…”

Section: Discussionmentioning

confidence: 99%

Pyloric Exclusion in the Treatment of Severe Duodenal Injuries: Results from the National Trauma Data Bank

DuBose

Inaba

Teixeira

et al. 2008

The American Surgeon

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Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade ≥ 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV–V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit.

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Section: Discussionmentioning

confidence: 99%

Pyloric Exclusion in the Treatment of Severe Duodenal Injuries: Results from the National Trauma Data Bank

DuBose

Inaba

Teixeira

et al. 2008

The American Surgeon

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“…To address these issues in the pediatric population, drainage of the stomach after excluding the pylorus may be done with tube gastrostomy, which can be removed if appropriate after the duodenal closure has healed. 34 Postoperative enteral feeds may be started early in this population by construction of a surgical tube jejunostomy placed distal to the injury.…”

Section: Managementmentioning

confidence: 99%

Pancreatic and Duodenal Trauma in Children

Lesher

Williams

2015

J Pediatr Intensive Care

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Penetrating injuries occur in 10% of pediatric trauma patients with injuries isolated to the pancreas in low velocity situations such as stab wounds and impalements. Injuries to the pancreas secondary to gunshot wounds often involve multiple systems, and the pancreas should be evaluated during operative exploration for penetrating injuries. The majority of pancreatic injuries in children occur after blunt trauma with handlebar injuries being the most common cause. 1 Child abuse, pedestrian struck, motor vehicle collision, and fall are other causes of pancreatic trauma with equivalent rates (10-20%). In a review comparing pancreatic injuries in children to adults, kids have a higher rate of injury secondary to bicycle accidents, are more likely to have isolated injuries, and have lower grade injuries than adults. 2 DiagnosisThe diagnosis of pancreatic injuries can be very difficult and usually starts with a high index of suspicion based on mechanism. A complete history and physical examination can be helpful, but physical examination findings are rare from most pancreatic injuries secondary to the retroperitoneal location of the pancreas and the higher frequency of isolated injuries in children. Laboratory values are often obtained though their significance in diagnosing and grading injury is questionable. Amylase and lipase are often used as a screening tool in patients with blunt abdominal trauma, though the sensitivity was only 84% in one study with a low positive predictive value related to the low prevalence of disease. 3 Another multicenter review revealed no correlation with grade of injury, length of stay, or mortality, 4 though one study did show a correlation of peak amylase level and major pancreatic injuries. 5 A variety of imaging modalities are available for evaluating the pancreas for injury. Computed tomography (CT) is often utilized for the workup of patients with abdominal trauma though historical studies reported low sensitivity and specificity for diagnosing pancreatic injury. 6 More recent studies examining multidetector CT have shown improved sensitivity and specificity for detecting pancreatic injury, though a multicenter study sponsored by the American Association for Trauma reported low sensitivity and high specificity for identifying pancreatic ductal injuries. 7,8 Additional imaging with magnetic resonance and endoscopic retrograde cholangiopancreatography are often used when ductal anatomy is difficult to ascertain. Studies evaluating the use of magnetic resonance imaging report favorable results, though the Keywords ► pancreatic injuries ► duodenal injuries ► blunt trauma ► pediatric Abstract Trauma is the leading cause of death in children of all ages. The most common site of injury in pediatric patients is the head followed by the extremities and the abdomen. Though less than 10% of admissions to the hospital are secondary to intra-abdominal injuries, mortality related to these injuries is not insignificant. Pancreatic and duodenal trauma occurs in 3 to 12% of the patients with abdom...

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“…Pyloric exclusion is a technique that helps to decompress the duodenum and allows healing followed by resumption of normal physiologic gastrointestinal transit from the pylorus to the duodenum as the pylorus reopens [9,10]. This highly effective technique is reserved usually for patients with complicated duodenal injuries, helping to reduce the morbidity from wound dehiscence, fistulas, abscesses, and peritonitis, while allowing for recovery of physiologic transit [11]. …”

Section: Discussionmentioning

confidence: 99%

Pyloric Exclusion for Treatment of Complicated Duodenal Atresia

Balakumar

DeRoss²,

Kouretas³

et al. 2014

Neonatology

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Duodenal atresia (DA) is a well-described congenital anomaly that usually responds well to surgical correction. Associated defects are common, and these confounding variables often influence outcome. The authors present a case of a newborn female with an unusual constellation of problems including DA with annular pancreas, trisomy 21, and coarctation of the aorta. She developed protracted complications postoperatively and was treated with an innovative surgical strategy.

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Modified pyloric exclusion for infants with complex duodenal injuries

Cited by 4 publications

References 13 publications

Pyloric Exclusion in the Treatment of Severe Duodenal Injuries: Results from the National Trauma Data Bank

Pyloric Exclusion in the Treatment of Severe Duodenal Injuries: Results from the National Trauma Data Bank

Pancreatic and Duodenal Trauma in Children

Pyloric Exclusion for Treatment of Complicated Duodenal Atresia

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