Duodenal injury. Analysis of common misconceptions in diagnosis and treatment.

Abstract:

:Seventy-five consecutive patients who sustained injuries to the duodenum were admitted to our hospital over a nine-year period. Nineteen blunt injuries and 56 penetrating injuries were encountered. Blunt injuries were usually the result of motor vehicle accidents and steering wheel impact was frequently implicated. Penetrating injuries most commonly followed gunshot wounds, particularly those where the bullet tract travelled transversely across the peritoneal cavity. Seventy-nine per cent of the patients had two or more associated intra-abdominal organ injuries with other intestinal injuries, biliary tract injuries, and pancreatic injuries predominating. Forty-seven per cent of the patients were admitted in shock. Following blunt injury, diagnostic delay was encountered in two patients. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels, and contrast gastroduodenography, were not helpful. Peritoneal lavage, however, was valuable in patients with equivocal physical findings. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum to provide exposure of the entire duodenum was necessary. Six injuries that initially appeared trivial would have been missed had this procedure not been followed. Suture closure was the most common reparative technique used. Tube decompression of the duodenum was a valuable addition. No suture line dehiscences were encountered in ten patients so treated. Overall mortality in patients surviving more than 24 hours was 12%.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Flint LM Jr,McCoy M,Richardson JD,Polk HC Jr

doi

10.1097/00000658-198006000-00006

subject

Has Abstract

pub_date

1980-06-01 00:00:00

pages

697-702

issue

6

eissn

0003-4932

issn

1528-1140

journal_volume

191

pub_type

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