Duodenal lesions management

Authors

  • Maria A. Lastra Santiago Department of Surgery, Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico
  • Gustavo E. Muñoz Delgado Department of Surgery, Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional de Occidente, Guadalajara, Jalisco, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20231008

Keywords:

Injuries, Duodenum, Surgical treatment

Abstract

Penetrating injuries are more typical overall, and traumatic damage to the duodenum only happens in 3 to 5% of individuals with abdominal injury. The majority of blunt injuries in the US are brought on by auto accidents. Lesions are evenly dispersed across the other sections of the duodenum, with the second segment being more frequently afflicted. Duodenal damage symptoms are non-specific and could be less noticeable after retroperitoneal surgery. Computed tomography (CT) is used to evaluate the duodenum in the diagnosis of duodenal injury in hemodynamically stable patients. CT findings related to this evaluation include duodenal thickening, periduodenal fluid, extraluminal air, and accumulation of heterogeneous fluid (clot) close to the site of injury. According to the mechanism and severity of the damage, the care of duodenal lesions should be cautious in patients with grade I or grade II closed duodenal hematoma who are hemodynamically stable. When duodenal lesions need to be repaired, surgery is necessary. With death rates of about 15%, duodenal injury complications include intra-abdominal abscess, duodenal fistula, and post-traumatic pancreatitis.

References

Carrillo EH, Richardson JD, Miller FB. Evolution in the management of duodenal injuries. J Trauma Acute Care Surg, 1996;40(6):1037-46.

Kanich W, Brady WJ, Huff JS, Perron AD, Holstege C, Lindbeck G, Carter CT. Altered mental status: evaluation and etiology in the ED. Am J Emergency Med. 2002;20(7):613-7.

Allen GS, Moore FA, Cox Jr CS, Mehall JR, Duke JH. Delayed diagnosis of blunt duodenal injury: an avoidable complication. J Am College Surgeons. 1998;187(4):393-9.

Santos EG, Sanchez AS, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: review of the literature. Cirugía Española (English Edition), 2015;93(2):68-74.

Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Coimbra R. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emergency Surg. 2013;14(1):1-23.

Melamud K, LeBedis CA, Soto JA. Imaging of pancreatic and duodenal trauma. Radiologic Clin. 2015;53(4):757-71.

Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE, Wallach MT. CT of the duodenum: an overlooked segment gets its due. Radiographics. 2001;21(1):S147-60.

Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Coimbra R. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emergency Surg. 2019;14(1):1-23.

Ratnasekera A, Ferrada P. Traumatic duodenal injury: Current management update. Curr Surg Rep. 2020;8:1-6.

Reynolds N, McWhirter JP, Pennington CR. Nutrition support teams: an integral part of developing a gastroenterology service. Gut. 1995;37(6):740.

Biffl WL, Moore EE, Croce M, Davis JW, Coimbra R, Karmy-Jones R, Feliciano D. Western Trauma Association critical decisions in trauma: management of pancreatic injuries. J Trauma Acute Care Surg. 2013;75(6):941-6.

Nakao A. The mesenteric approach in pancreatoduodenectomy. Digestive Surg. 2016;33(4):308-13.

Weinberg JA, Croce MA. Penetrating injuries to the stomach, duodenum, and small bowel. Current Trauma Rep. 2015;1:107-12.

Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP. 2012;13(1):18-25.

McArthur BJ.Damage control surgery for the patient who has experienced multiple traumatic injuries. AORN J. 2006;84(6):991-1000.

Han JH, Hong SI, Kim HS, Ryu BY, Kim HK. Multilevel duodenal injury after blunt trauma. J Kor Surgical Society. 2009;77(4):282-6.

Degiannis E, Boffard K. Duodenal injuries. Br J Surg. 2000;87(11):1473-9.

Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer III LR et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg. 2006;39(6):867-71.

Weishaupt D, Grozaj AM, Willmann JK, Roos JE, Hilfiker PR, Marincek B. Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol. 2002;12:1295-311.

Downloads

Published

2023-03-31

Issue

Section

Review Articles