title: Injuries to the duodenum--prognosis correlates with body Injury Severity Score: a prospective study.
abstract: BACKGROUND
  Duodenal injury is an important hollow viscus injury in the abdomen. The study analysed the factors related to the outcome of duodenal injuries presenting to the unit.
  
  
  METHODS
  Prospectively collected data on a case series involving 23 patients over three years. It involved demographic details, Injury Severity Score, Revised Trauma Score, part of duodenum injured, duodenal injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. Patients with non-perforating injury were excluded.
  
  
  RESULTS
  M:F ratio was 9:2. Median age was 33 years. All were operated by a senior registrar or senior. Seven out of 23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Duodenal injury severity was graded according to American Association for Surgery of Trauma-Organ Injury Scale (AAST-OIS). Seventeen/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18 h. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs were required for 3/23 patients. Five patients died. Duodenum-related mortality was zero. The mortality was related to body Injury Severity Score >45. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Adverse prognostic factors towards morbidity was injury-operation lag >18 h.
authors.affiliation: Casualty and Emergency Block, Department of Surgery, Mayo Hospital, King Edward Medical College, Lahore, Pakistan. munirrathore@yahoo.com
authors.forename: Munir Ahmad
authors.initials: MA
authors.lastname: Rathore
authors.forename: Syed Imran Hussain
authors.initials: SI
authors.lastname: Andrabi
authors.forename: Syed Muzahir
authors.initials: SM
authors.lastname: Najfi
authors.forename: Zafarullah
authors.initials: Z
authors.lastname: Chaudhry
authors.forename: Abdul Majeed
authors.initials: AM
authors.lastname: Chaudhry
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating; D014950:Wounds, Penetrating