| Abstract [eng] |
Background / objective To evaluate the results of surgical management of duodenal injuries. Patients and methods A retrospective analysis of all patients with surgically identified duodenal injuries treated over a 20-year period in the two emergency health care institutions. Results In 27 patients studied, there were seven deaths (25.9%) and an overall complication rate of 48.1%. The morbidity related to abdominal organ injury was 37% (10 patients). Suture dehiscence with fistula formation with or without diffuse peritonitis developed in seven patients (29.5%). There were 54 associated intraabdominal injuries in 23 patients. The mesenterium, small bowel and pancreas were more frequently injured organs (29.6%, 25.9% and 25.9%, respectively). The average value of the abdominal trauma index (ATI) was 23 (range, 9 to 52). The value of the abdominal trauma index more than 25 was associated with a 1.6 times more frequent morbidity rate and 1.8 times more frequent mortality rate (p > 0.05). According to AAST OIS, grade III of the injury was associated with a 60% morbidity rate and was approximately 2 times more frequent than in cases of the first and second grades of injury (33.3% vs. 31.6%, p > 0,05). The preoperative haemodinamic status was not associated with a higher morbidity rate (unstable vs. stable as 42.8% vs. 35%, p > 0.05), but mortality in the cases of haemodynamic instability was more than two timer higher (unstable vs. stable as 42.8% vs. 20%, p > 0.05). The preoperative time more than 24 hours was associated with approximately a two times higher morbidity rate (60% vs. 31.8%, p > 0.05) and a three times higher mortality rate (60% vs. 18.1%, p > 0,05). Primary duodenorrhaphy without any other procedures was performed in 13 patients (48%). Primary duodenorrhaphy with biliary drainage was performed in 7 patients (29.5%) and primary duodenorrhaphy with gastroenterostomy, without pyloric exclusion, with or without biliary drainage was done in 2 patients and primary repair with pyloric exclusion and gastroenterostomy with or without biliary drainage in 5 (18.5%). The method of the operation did not account for the grade of injury according to AAST OIS. Jejunostomy for enteral feeding was done in seven patients (29.5%). Failures of duodenal repair were recorded in seven cases (29.5%). Six of all failures were detected after primary repair without pylorus exclusion procedure with or without biliary tract drainage. No failures were detected after the pylorus exclusion procedure. Biliary tract drainage did not prevent repair failure. Conclusions Traumatic duodenal injuries are uncommon but most dangerous of the injuries of the digestive tract. Associated intraabdominal injuries are rather a rule than exception. Mortality and morbidity are still high and associated with a long duration of the preoperative period, the grade of injury, and the number of the associated intraabdominal injuries. Pyloric exclusion, based on individualised intraoperative assessment, can minimise duodenum-related morbidity. Biliary drainage did not protect from suture failure. |
