Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 1 ( January-April, 2017 ) > List of Articles

ORIGINAL ARTICLE

Duodenal Trauma: Incidence and Management in Penetrating and Blunt Abdominal Trauma

Michael W Parra, Otto M Rosa, Orlando C Filho, Stephanie Santin, Alexandre Z Fonseca, Bianca E Alvarez, Marcelo AF Ribeiro Jr

Citation Information : Parra MW, Rosa OM, Filho OC, Santin S, Fonseca AZ, Alvarez BE, Ribeiro Jr MA. Duodenal Trauma: Incidence and Management in Penetrating and Blunt Abdominal Trauma. Panam J Trauma Crit Care Emerg Surg 2017; 6 (1):13-16.

DOI: 10.5005/jp-journals-10030-1166

License: CC BY 3.0

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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.

How to cite this article

Ribeiro MAF Jr, Rosa OM, Filho OC, Santin S, Fonseca AZ, Alvarez BE, Parra MW. Duodenal Trauma: Incidence and Management in Penetrating and Blunt Abdominal Trauma. Panam J Trauma Crit Care Emerg Surg 2017;6(1):13-16.

Racional

As lesões duodenais são raras e quando identificadas habitualmente se associam ao trauma abdominal penetrante, especialmente ferimentos por arma de fogo, com maior prevalência entre os homens jovens. A utilização de procedimentos cirúrgicos mais simples e eficazes também contribui para a redução das taxas de mortalidade e morbidade.

Objetivo

Avaliar os casos de traumatismo duodenal penetrante e contunso, a complexidade das lesões, incidência, manejo bem como morbidade e mortalidade.

Métodos

Análise retrospectiva de 1039 prontuários médicos de pacientes atendidos no Hospital Geral de Grajaú, entre janeiro de 2010 e maio de 2014, que foram submetidos à laparotomia exploradora de emergência. Destes casos, 298 apresentavam traumas abdominais contusos ou penetrantes, sendo que destes, 11 apresentavam traumas duodenais.

Resultados

Observou-se predominância de adultos jovens (idade média de 26,48 anos) e todos os pacientes eram do sexo masculino (100%), dos quais 1 apresentava traumatismo abdominal contuso, 3 de ferimentos por arma branca e 7 por arma de fogo. A maioria das lesões duodenais foram classificadas como lesões de Grau II e mais comumente envolvidos na quarta porção do duodeno. Enfatizamos a associação com lesões a outros órgãos, especialmente ao fígado e ao intestino delgado. Nos casos analisados, destacamos a importância do tempo entre a entrada do serviço e a cirurgia em todos os pacientes com menos de 6 horas. A cirurgia mais comum realizada para reparar essas lesões foi duodenorrafia (90,9%). Nesta série, houve 4 mortes. As complicações pós-operatórias incluíram fístulas duodenais com resolução espontânea.

Conclusão

As lesões duodenais são raras e são mais fequentes perante ferimentos abdominais penetrantes, especialmente ferimentos por arma de fogo, com maior prevalência entre homens jovens. É necessário um diagnóstico precoce e uma intervenção cirúrgica rápida, procedimentos cirúrgicos devem ser abreviados, devido à morbidade/mortalidade e alta complexidade dessas lesões. A intervenção deve ser precoce e o procedimento cirúrgico deve ser preciso e eficaz.


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