title: Penetrating duodenal trauma: A 19-year experience.
abstract: BACKGROUND
  Multiple techniques are used for repair in duodenal injury ranging from simple suture repair for low-grade injuries to pancreaticoduodenectomy for complicated high-grade injuries. Drains, both intraluminal and extraluminal, are placed variably depending on associated injuries and confidence with the repair. It is our contention that a simplified approach to repair will limit complications and mortality. The major complication of duodenal leak (DL) was the outcome used to assess methods of repair in this study.
  
  
  METHODS
  After early deaths from associated vascular injuries were excluded, patients with a penetrating duodenal injury admitted during a 19-year period ending in 2014 constituted the study population.
  
  
  RESULTS
  A total of 125 patients with penetrating duodenal injuries were included. Overall, the leak rate was 8% with two duodenal-related mortalities. No differences were seen in patients who had a DL as compared with no leak with respect to demographics, injury severity, or admission variables. Patients with DL were more likely to have a major vascular injury (60% vs. 23%, p = 0.02) and a combined pancreatic injury (70% vs. 31%, p = 0.03). No differences were identified by repair technique, location, or grade of injury. DLs were more likely to have an extraluminal drain (90% vs. 45%, p = 0.008).
  
  
  CONCLUSIONS
  Primary suture repair should be the initial approach considered for most injuries. Major vascular injuries and concomintant pancreatic injuries were associated with most leaks; therefore, adjuncts to repair including intraluminal drainage and pyloric exclusion should be considered on the initial operation. Extraluminal drains should be avoided unless required for associated injuries.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the Department of Surgery (T.J.S., K.S., J.P.S., L.J.M., J.A.W., M.A.C., T.C.F.), University of Tennessee Health Science Center, Memphis, Tennessee; and Department of Surgery (P.E.F.), Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.forename: Kashif
authors.initials: K
authors.lastname: Saleem
authors.forename: John P
authors.initials: JP
authors.lastname: Sharpe
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D019468:Disease Management; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013714:Tennessee / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult