Surgical treatment and outcome after delayed diagnosis of blunt duodenal injury.
OBJECTIVE
To review our experience of 18 patients with duodenal injuries after blunt trauma, the diagnosis of which had been delayed for more than 24 hours.


METHODS
Retrospective study.


METHODS
Teaching hospital, Taiwan, R.O.C.


METHODS
18 patients who presented with duodenal injuries between January 1986 and December 1995.


METHODS
Morbidity and mortality.


RESULTS
The reasons for the delay were: injuries not found during the first operation (n = 6), patients had not sought medical help (n = 6), and injuries treated conservatively at local hospitals (n = 5). There was one delay in our department because the patient lost consciousness. 12 patients were treated by pyloric exclusion with no deaths and four complications (one duodenal fistula and 3 retroperitoneal abscesses). The other 6 had various operations including pancreaticoduodenectomy, jejunostomy, and gastrostomy, with six complications and one death, giving an overall mortality of 6% and morbidity of 50%. Three patients developed delayed extensive retroperitoneal abscesses and all three were treated successfully by laparostomy. 16 of the 18 patients required enteral feeding through a jejunostomy.


CONCLUSIONS
Though the complication rate was high, the use of pyloric exclusion and a feeding jejunostomy kept the mortality low. Enteral nutrition should be started early. Laparostomy is a good way to manage retroperitoneal abscesses. To avoid delay, patients at risk of duodenal injuries should be evaluated early by experienced trauma surgeons and any central retroperitoneal haematoma should be explored during the initial laparotomy.
Fang
J F
JF
Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung College of Medicine and Technology, Taiwan, R.O.C.
Chen
R J
RJ
Lin
B C
BC
D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000293:injuries* / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*