Analysis of surgical treatment of traumatic duodenal injury_West China Medical Journal

Authors：

RU Hao , KUO Wenlei , LIU Chang , DONG Zepeng , SUN Xuejun ,  SUN Qi

Department of General Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, P. R. China;

Corresponding?author：

SUN Qi, Email: sunqi4875@163.com

Keywords：

Blunt abdominal trauma; duodenal injury; surgery

DOI：

10.7507/1002-0179.202409198

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Objective To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results A total of 8 patients were included. Among them, there were 7 males and 1 female. The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old. There were 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury. There was 1 case of duodenal bulb injury, 3 cases of descending part injury, 3 cases of horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for duodenal trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which 2 cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Adequate postoperative enteric decompression and drainage should be ensured.

Citation： RU Hao, KUO Wenlei, LIU Chang, DONG Zepeng, SUN Xuejun, SUN Qi. Analysis of surgical treatment of traumatic duodenal injury. West China Medical Journal, 2024, 39(11): 1714-1717. doi: 10.7507/1002-0179.202409198 Copy

1.	Aiolfi A, Matsushima K, Chang G, et al. Surgical trends in the management of duodenal injury. J Gastrointest Surg, 2019, 23(2): 264-269.
2.	楊秀峰, 白化天, 呂瑞光, 等. 十二指腸損傷的診斷與治療. 世界最新醫學信息文摘, 2016, 16(25): 105-106.
3.	Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, Ⅱ: pancreas, duodenum, small bowel, colon, and rectum. J Trauma, 1990, 30(11): 1427-1429.
4.	張國強, 吳喬. 十二指腸損傷的外科處理與經驗分析. 華西醫學, 2013, 28(9): 1426-1428.
5.	Melamud K, LeBedis CA, Soto JA. Imaging of pancreatic and duodenal trauma. Radiol Clin North Am, 2015, 53(4): 757-771.
6.	盛小明, 虞俊波, 郭青松, 等. 十二指腸損傷的診治策略. 創傷外科雜志, 2020, 22(4): 306-309.
7.	Farrell RJ, Krige JE, Bornman PC, et al. Operative strategies in pancreatic trauma. Br J Surg, 1996, 83(7): 934-937.
8.	李賓. 胰十二指腸切除術治療嚴重胰頭、十二指腸損傷的體會. 醫學與哲學(B), 2017, 38(11): 13-14.
9.	顏晨, 江勇, 吳寶強, 等. 閉合性胰腺合并十二指腸損傷的急診胰十二指腸切除術 4 例. 肝膽胰外科雜志, 2015, 27(1): 56-57.
10.	Laing GL, Ghimenton F, Clarke DL. A paediatric case of AAST grade Ⅳ duodenal injury with application of damage control surgery. S Afr J Surg, 2013, 51(3): 111-112.
11.	Siboni S, Benjamin E, Haltmeier T, et al. Isolated blunt duodenal trauma: simple repair, low mortality. Am Surg, 2015, 81(10): 961-964.
12.	龔昆梅, 郭世奎, 王昆華. 十二指腸損傷和十二指腸瘺的診治經驗. 中華胃腸外科雜志, 2017, 20(3): 266-269.
13.	任建安, 黎介壽. 術中十二指腸損傷及并發十二指腸瘺的診治. 中國實用外科雜志, 2005(9): 522-524.
14.	沈小群, 袁文琴, 陳靈芝, 等. 十二指腸腔內雙套管負壓吸引在十二指腸破裂修補術中的應用價值. 中國基層醫藥, 2015(20): 3113-3115.
15.	王昆華, 劉為軍, 肖樂, 等. 雙管與三管引流在十二指腸損傷修復中的比較. 中華外科雜志, 2012, 50(5): 471-472.
16.	劉恒山, 朱高波, 宋京翔, 等. Hassan 三管法和雙管法在十二指腸損傷修補術中的臨床應用. 腹部外科, 2023, 36(3): 217-221.
17.	張帥, 費發珠, 韓欣, 等. 三維 CT 重建聯合吲哚菁綠顯影技術應用于腹腔鏡保留十二指腸胰頭切除術 2 例報道. 中國普外基礎與臨床雜志, 2024, 31(7): 870-873.

1. Aiolfi A, Matsushima K, Chang G, et al. Surgical trends in the management of duodenal injury. J Gastrointest Surg, 2019, 23(2): 264-269.
2. 楊秀峰, 白化天, 呂瑞光, 等. 十二指腸損傷的診斷與治療. 世界最新醫學信息文摘, 2016, 16(25): 105-106.
3. Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, Ⅱ: pancreas, duodenum, small bowel, colon, and rectum. J Trauma, 1990, 30(11): 1427-1429.
4. 張國強, 吳喬. 十二指腸損傷的外科處理與經驗分析. 華西醫學, 2013, 28(9): 1426-1428.
5. Melamud K, LeBedis CA, Soto JA. Imaging of pancreatic and duodenal trauma. Radiol Clin North Am, 2015, 53(4): 757-771.
6. 盛小明, 虞俊波, 郭青松, 等. 十二指腸損傷的診治策略. 創傷外科雜志, 2020, 22(4): 306-309.
7. Farrell RJ, Krige JE, Bornman PC, et al. Operative strategies in pancreatic trauma. Br J Surg, 1996, 83(7): 934-937.
8. 李賓. 胰十二指腸切除術治療嚴重胰頭、十二指腸損傷的體會. 醫學與哲學(B), 2017, 38(11): 13-14.
9. 顏晨, 江勇, 吳寶強, 等. 閉合性胰腺合并十二指腸損傷的急診胰十二指腸切除術 4 例. 肝膽胰外科雜志, 2015, 27(1): 56-57.
10. Laing GL, Ghimenton F, Clarke DL. A paediatric case of AAST grade Ⅳ duodenal injury with application of damage control surgery. S Afr J Surg, 2013, 51(3): 111-112.
11. Siboni S, Benjamin E, Haltmeier T, et al. Isolated blunt duodenal trauma: simple repair, low mortality. Am Surg, 2015, 81(10): 961-964.
12. 龔昆梅, 郭世奎, 王昆華. 十二指腸損傷和十二指腸瘺的診治經驗. 中華胃腸外科雜志, 2017, 20(3): 266-269.
13. 任建安, 黎介壽. 術中十二指腸損傷及并發十二指腸瘺的診治. 中國實用外科雜志, 2005(9): 522-524.
14. 沈小群, 袁文琴, 陳靈芝, 等. 十二指腸腔內雙套管負壓吸引在十二指腸破裂修補術中的應用價值. 中國基層醫藥, 2015(20): 3113-3115.
15. 王昆華, 劉為軍, 肖樂, 等. 雙管與三管引流在十二指腸損傷修復中的比較. 中華外科雜志, 2012, 50(5): 471-472.
16. 劉恒山, 朱高波, 宋京翔, 等. Hassan 三管法和雙管法在十二指腸損傷修補術中的臨床應用. 腹部外科, 2023, 36(3): 217-221.
17. 張帥, 費發珠, 韓欣, 等. 三維 CT 重建聯合吲哚菁綠顯影技術應用于腹腔鏡保留十二指腸胰頭切除術 2 例報道. 中國普外基礎與臨床雜志, 2024, 31(7): 870-873.

West China Medical Journal

Analysis of surgical treatment of traumatic duodenal injury

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