Surgical management of duodenal injuries in children.
BACKGROUND
The goal of this study was to review current injury characteristics, severity, intervention, and outcome of duodenal injuries from a single, pediatric trauma facility.


METHODS
A retrospective review was performed of duodenal injuries in children less than 16 years of age from 1990 to 2000.


RESULTS
Twelve children had duodenal injuries as a result of blunt abdominal trauma. Six injuries were the result of motor vehicle crashes. Nonaccidental trauma (2) and contact injury (4) provided the remaining cases. Diagnosis was achieved by abdominal computed tomography. Severity of duodenal injury included grade I (1), II (8), and III (3). Seven patients had associated visceral or neurologic injuries. Average Injury Severity Score was 18. Duodenal repair was required in 9 of the 10 patients explored. Treatment included observation (3); primary repair, alone, (2) or with proximal decompression (4); and pyloric exclusion with gastrojejunostomy (3). Exclusion techniques had fewer complications (0% vs 57%) and fewer hospital days (19 vs 23).


CONCLUSIONS
Blunt abdominal trauma remains the most prevalent mechanism for pediatric duodenal injuries. Patients undergoing pyloric exclusion for severe duodenal trauma had a lesser morbidity and a shorter hospital stay in this small series. Pyloric exclusion remains an alternative for the treatment of severe duodenal injuries in selected children.
Ladd
Alan P
AP
J.W. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Ind 46202, USA.
West
Karen W
KW
Rouse
Thomas M
TM
Scherer
L R
LR
Rescorla
Frederick J
FJ
Engum
Scott A
SA
Grosfeld
Jay L
JL
D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004386:Duodenum / Q000293:injuries*; D006801:Humans; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000601:surgery*