| 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 22-year period in two emergency health care institutions. Results In 32 patients studied, there were eight deaths (25%) and an overall complication rate of 53.1%. The morbidity related to abdominal injury was 40.6% (13 patients). Suture dehiscence with fistula formation with or without diffuse peritonitis developed in nine patients (28.1%). There were 58 associated abdominal injuries in 24 patients. The mesenterium, small bowel and pancreas were most frequently injured organs (25%, 21.9% and 21.9%, respectively). The average value of the abdominal trauma index (ATI) was 21.9 (range, 9 to 52). The value of the abdominal trauma index more than 25 was associated with a 1.25 times higher morbidity rate and 1.8 times higher mortality rate (p > 0.05). According to AAST OIS, grade III of the injury was associated with 62.5% of duodenal fistula cases and was approximately 4 times more frequent than in cases of the first and second grades of injuries (0% and 19%, p < 0.05). The preoperative haemodynamic status was not significantly associated with a higher morbidity rate, but the mortality in cases of haemodynamic instability was more than two timer higher (unstable vs. stable as 50% / 17.4%, p > 0.05). The preoperative time more than 24 hours was associated with an approximately twice as high morbidity rate (80% vs. 33.3%, p > 0.05) and a two times higher mortality rate (40% vs. 22.2%, p > 0.05). Primary repair without any other procedures was employed in 16 patients (50%). Primary repair with gastroenterostomy, without pyloric exclusion was employed in one patient (3.1%), primary repair with pyloric exclusion and gastroenterostomy in four (12.5%), primary repair with biliary drainage in seven (21.9%), primary repair with gastroenterostomy and biliary drainage in one patient (3.1%), and primary repair with pyloric exclusion, gastroenterostomy and biliary drainage in three patients (9.4%). Jejunostomy for enteral feeding was performed in ten patients (31.2%). Failures of duodenal repair were recorded in nine cases (28.1%). Three of all failures (18.7%) were detected after primary repair without any other procedures. Primary repair with complex treatment was associated with a higher rate of duodenal repair failure (6 of 16, 37.5%). According to the localisation of duodenal injury, injuries of the D3 part of the duodenum were associated with the highest rate of abdominal complications (66.7%) and failures of repair (50%) (p < 0.05). Conclusions Traumatic duodenal injuries are uncommon but most dangerous injuries of the digestive tract. Associated intraabdominal injuries are rather a rule than an exception. Mortality and morbidity are still high and depend on the duration of the preoperative period, the grade and the location of the injury, and the severity of the associated intraabdominal injuries. Primary repair in cases of injury grade I–III is associated with a lower rate of complications. |
