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Surgical management of duodenal injury: experience from 92 cases

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Duodenal injury increases with traffic accidents, and delayed diagnosis or inappropriate operation increase mortality and complications. This study aimed to explore early recognition and timely surgical intervention.

Methods

All patients with duodenal injuries treated operatively during the past 10 years were reviewed, and the data were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome.

Results

A total of 92 patients with duodenal injuries accounted for 7.3% of 1258 patients with abdominal injury. Of the 92 patients, 71 (77.17%) experienced blunt trauma, with traffic accidents accounting for 59.2% (42/71). In 35 patients, a preoperative diagnosis was obtained by reviewing abdominal signs, peritoneocentesis, and imaging. The remaining 57 patients underwent urgent laparotomy, through which a definitive diagnosis of duodenal injury was confirmed during the operation. In all 92 patients, the surgical procedures involved simple sutures; pedicled jejunal piece coverings; and various anastomoses following resection of the injured duodenal portion, including the Whipple procedure and damage-control surgery principles. The overall mortality rate was 12.0% (11/92) with deaths mainly occurring due to associated injuries. When excluding 2 cases of intraoperative death, there were 47 cases in the double-tube gastrostomy group and 43 cases in the traditional triple-tube group, with mortality rates of 10.64% and 9.30% in the two groups, respectively (χ2 = 0.045, P > 0.05). Postoperative complications occurred in 15 patients (18.5%). There was a high incidence of duodenal (or pancreatic/biliary) leakage.

Conclusion

Early diagnosis and operation of duodenal injury are crucial to reducing complications and mortality. Surgical methods should be based on injury grade, associated injuries, and vital signs. Double-tube gastrostomy can reduce complications such as intestinal obstruction.

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Funding

The authors received no funding for this work.

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Authors and Affiliations

  1. Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China

    Jinmou Gao, Hui Li, Jun Yang, Jianbai Wang, Tao Ai, Ping He, Gongbin Wei, Zhen Xiang & Shanhong Zhao

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  1. Jinmou Gao
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  2. Hui Li
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  3. Jun Yang
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  4. Jianbai Wang
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  5. Tao Ai
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  7. Gongbin Wei
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  8. Zhen Xiang
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  9. Shanhong Zhao
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Contributions

JG: data collection, study design, manuscript writing and editing; HL: data collection and analysis, review; JY: data collection, review; JW: assisting in data collection and analysis; TA: assisting in data collection and analysis; PH: assisting in data collection; GW: data collection and analysis, review; ZX: assisting in data collection; SZ: assisting in data collection.

Corresponding author

Correspondence to Jinmou Gao.

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Conflict of interest

The authors have no conflict of interest to report and have received no financial or material support related to this manuscript.

Ethical approval

Because no human subjects were involved in the manuscript and because only deidentified data were used, the requirement for an ethical review and informed consent was waived by the Institutional Review Board of Chongqing Emergency Medical Center (CEMC), China.

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Informed consent was obtained from all individual participants included in the study.

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Gao, J., Li, H., Yang, J. et al. Surgical management of duodenal injury: experience from 92 cases. Eur J Trauma Emerg Surg 49, 1367–1374 (2023). https://doi.org/10.1007/s00068-023-02238-4

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  • DOI: https://doi.org/10.1007/s00068-023-02238-4

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