title: Operative approach in traumatic injuries of the duodenum.
abstract: BACKGROUND
  The management of duodenal traumas remains controversial. The experience of Ankara Numune Training and Research Hospital Emergency Surgery Department with duodenal injuries during a 10-year period was analyzed to identify trends in operative management and sources of duodenum-related morbidity and mortality.
  
  
  RESULTS
  Between 1994 and 2003, 1799 patients with blunt abdominal trauma were operated on and the incidence of duodenal trauma was 2.8% (50 patients). The injuries were penetrating in 31 (62%) patients and blunt in 19 (38%). Primary repair (PR) of injury was performed in 24 (48%) patients, primary repair and tube duodenostomy (PRTd) in 8 (16%) patients, complex repair (CR) in 11 (22%) patients, and exploration only without a duodenal procedure in 5 (10%) patients. Two of the patients died during laparotomy. The mortality rate was 12% and the incidence of duodenum-related morbidity was 12%. The overall morbidity rate was 40% (20 patients). The most commonly injured portion of the duodenum was DII (58%), and the most frequent cause of duodenum-related and overall morbidity in our series was Grade III duodenal injury.
  
  
  CONCLUSIONS
  Our experience suggests that the use of primary repair in grade III injury may be associated with higher duodenum-related morbidity. Our recommendation is to use complex repair for grade III duodenal injuries.
authors.affiliation: Ankara Numune Training and Research Hospital, 2nd Department of General Surgery, Ankara, Turkey. b2bozkurt@yahoo.com
authors.forename: B
authors.initials: B
authors.lastname: Bozkurt
authors.forename: B A
authors.initials: BA
authors.lastname: Ozdemir
authors.forename: B
authors.initials: B
authors.lastname: Kocer
authors.forename: B
authors.initials: B
authors.lastname: Unal
authors.forename: M
authors.initials: M
authors.lastname: Dolapci
authors.forename: O
authors.initials: O
authors.lastname: Cengiz
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D004385:Duodenostomy / Q000379:methods; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D022125:Lacerations / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery