title: The use of pyloric exclusion for treating duodenal trauma: case series.
abstract: OBJECTIVE
  Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma.
  
  
  METHODS
  Cross-sectional study followed by a case series in a university hospital.
  
  
  METHODS
  Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed.
  
  
  RESULTS
  The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients).
  
  
  CONCLUSIONS
  Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas. fragagp@uol.com.br
authors.forename: Gustavo Pereira
authors.initials: GP
authors.lastname: Fraga
authors.forename: Guilherme
authors.initials: G
authors.lastname: Biazotto
authors.forename: José Benedito
authors.initials: JB
authors.lastname: Bortoto
authors.forename: Nelson Adami
authors.initials: NA
authors.lastname: Andreollo
authors.forename: Mario
authors.initials: M
authors.lastname: Mantovani
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D055815:Young Adult