Duodenal organ injury severity (OIS) and outcome.
The effect of organ injury severity on outcome was assessed in 101 patients treated for duodenal trauma. Most patients were men (89%) and victims of penetrating wounds (93%). Grade I is minor hematoma or incomplete perforation; Grade II is major hematoma or small complete perforation; Grade III is large perforation excluding ampulla; Grade IV is large perforation at ampulla; Grade V is duodenopancreatic crunch. The injuries were as follows: Grade I (5 patients), Grade II (31), Grade III (40), Grade IV (12), and Grade V (13). Fourteen patients exsanguinated from associated vessel injury; each had Grade IV or Grade V injury. All 36 patients with Grade I and Grade II injury had primary repair; the single death was due to liver necrosis. Most (31 patients) Grade III injuries and three Grade IV injuries were treated by primary repair alone; the three deaths were unrelated to the duodenal injury. Other major injuries were treated by duodenal exclusion (4 patients), duodenal diverticulization (6), or resection (4); the single death was unrelated to the duodenum. Primary closure is favored for minor injuries and most Grade III injuries. Severe injuries may require exclusion, diverticulization, or resection.
Kline
G
G
Department of Surgery, Wayne State University, Detroit, MI 48201.
Lucas
C E
CE
Ledgerwood
A M
AM
Saxe
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008824:Michigan; D008875:Middle Aged; D014193:Trauma Centers; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000145:classification* / Q000150:complications / Q000401:mortality / Q000601:surgery