Retroperitoneal laparostomy: An effective treatment of extensive intractable retroperitoneal abscess after blunt duodenal trauma

Jen Feng Fang, Ray Jade Chen, Being Chuan Lin, Yu Bau Hsu, Jung Liang Kao, Yi Chin Kao, Miin Fu Chen

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23 Citations (Scopus)

Abstract

Background: Delay in surgical treatment and duodenal wound dehiscence are two major causes of extensive retroperitoneal abscess formation after blunt duodenal injury. This complication is traditionally treated with primary repair of the duodenal wound and drainage of the abscess through anterior laparotomy. Pyloric exclusion is sometimes added as an adjunctive procedure. The anterior approach, however, may result in inadequate drainage, and repeat surgery is sometimes needed. We reviewed our experiences and evaluated the effectiveness of retroperitoneal laparostomy for the treatment of retroperitoneal abscess with continuous soiling. Methods: There were 52 blunt duodenal injuries during a 7-year period. Eleven patients developed extensive retroperitoneal abscesses. Results: All 11 patients were treated with anterior laparotomy initially. Five patients recovered after this procedure. Six patients continued to have retroperitoneal abscesses and were under septic status. Two patients received another anterior drainage, and had recurrent abscesses later. Retroperitoneal laparostomy was performed for these six patients. After retroperitoneal laparostomy, daily wound care, and antibiotic treatment, all six patients recovered. Only two patients developed incisional hernia. Conclusion: Retroperitoneal laparostomy is effective in treating extensive intractable retroperitoneal abscess after blunt duodenal injury. Patients with the complications of duodenal leak and extensive retroperitoneal abscess should be treated with pyloric exclusion and drainage through anterior laparotomy first. If the duodenal wound does not heal after pyloric exclusion and retroperitoneal abscess persists, retroperitoneal laparostomy should be performed without further attempt to repair the wound.

Original languageEnglish
Pages (from-to)652-655
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume46
Issue number4
Publication statusPublished - Apr 1999
Externally publishedYes

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Keywords

  • Duodenal injury
  • Retroperitoneal abscess
  • Retroperitoneal laparostomy

ASJC Scopus subject areas

  • Surgery

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