Surgical treatment and outcome after delayed diagnosis of blunt duodenal injury

Jen Feng Fang, Ray Jade Chen, Being Chuan Lin

研究成果: 雜誌貢獻文章同行評審

30 引文 斯高帕斯(Scopus)

摘要

Objective: To review our experience of 18 patients with duodenal injuries after blunt trauma, the diagnosis of which had been delayed for more than 24 hours. Design: Retrospective study. Setting: Teaching hospital, Taiwan, R.O.C. Subjects: 18 patients who presented with duodenal injuries between January 1986 and December 1995. Main outcome measures: Morbidity and mortality. Results: The reasons for the delay were: injuries not found during the first operation (n = 6), patients had not sought medical help (n = 6), and injuries treated conservatively at local hospitals (n = 5). There was one delay in our department because the patient lost consciousness. 12 patients were treated by pyloric exclusion with no deaths and four complications (one duodenal fistula and 3 retroperitoneal abscesses). The other 6 had various operations including pancreaticoduodenectomy, jejunostomy, and gastrostomy, with six complications and one death, giving an overall mortality of 6% and morbidity of 50%. Three patients developed delayed extensive retroperitoneal abscesses and all three were treated successfully by laparostomy. 16 of the 18 patients required enteral feeding through a jejunostomy. Conclusions: Though the complication rate was high, the use of pyloric exclusion and a feeding jejunostomy kept the mortality low. Enteral nutrition should be started early. Laparostomy is a good way to manage retroperitoneal abscesses. To avoid delay, patients at risk of duodenal injuries should be evaluated early by experienced trauma surgeons and any central retroperitoneal haematoma should be explored during the initial laparotomy.

原文英語
頁(從 - 到)133-139
頁數7
期刊European Journal of Surgery, Acta Chirurgica
165
發行號2
DOIs
出版狀態已發佈 - 1999
對外發佈

ASJC Scopus subject areas

  • 手術

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