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Purpose: Duodenal injury increases with traffic accidents, and delayed diagnosis or inappropriate operation increase mortality and complications. This study aimed to explore early recognition and timely surgical intervention. Methods: All patients with duodenal injuries treated operatively during the past 10 years were reviewed, and the data were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. Results: A total of 92 patients with duodenal injuries accounted for 7.3% of 1258 patients with abdominal injury. Of the 92 patients, 71 (77.17%) experienced blunt trauma, with traffic accidents accounting for 59.2% (42/71). In 35 patients, a preoperative diagnosis was obtained by reviewing abdominal signs, peritoneocentesis, and imaging. The remaining 57 patients underwent urgent laparotomy, through which a definitive diagnosis of duodenal injury was confirmed during the operation. In all 92 patients, the surgical procedures involved simple sutures; pedicled jejunal piece coverings; and various anastomoses following resection of the injured duodenal portion, including the Whipple procedure and damage-control surgery principles. The overall mortality rate was 12.0% (11/92) with deaths mainly occurring due to associated injuries. When excluding 2 cases of intraoperative death, there were 47 cases in the double-tube gastrostomy group and 43 cases in the traditional triple-tube group, with mortality rates of 10.64% and 9.30% in the two groups, respectively (χ2 = 0.045, P > 0.05). Postoperative complications occurred in 15 patients (18.5%). There was a high incidence of duodenal (or pancreatic/biliary) leakage. Conclusion: Early diagnosis and operation of duodenal injury are crucial to reducing complications and mortality. Surgical methods should be based on injury grade, associated injuries, and vital signs. Double-tube gastrostomy can reduce complications such as intestinal obstruction. [ABSTRACT FROM AUTHOR]

Duodenal injuries are rare and difficult to diagnose, with an incidence between 1 and 5% in cases of abdominal trauma. We present the case of a 30-year-old man who suffered a motorcycle collision presented with a 24-hour history of abdominal pain, peritoneal tenderness, and hemodynamic instability. Imaging studies show evidence of free fluid in the perihepatic, perisplenic, and pelvic space. An exploratory laparotomy was performed, finding a grade III duodenal, grade V jejunal, and grade II pancreatic injuries. The basis of surgical treatment being a primary anastomosis of duodenal and jejunal injuries, which allowed discharging him home 8 days after surgery and without any complications in his follow-up.

Background and Objectives: Traumatic duodenal injury is a rare disease with limited evidence. We aimed to evaluate the risk factors for postoperative leakage and outcomes of pyloric exclusion after duodenal grade 2 and 3 injury. Materials and Methods: We reviewed a prospectively collected trauma database for the period January 2004–December 2020. Patients with grade 2 and 3 traumatic duodenal injury were included. To identify the risk factors for postoperative leakage, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) logistic model. We constructed a receiver operator characteristic (ROC) curve to predict risk factors for postoperative leakage. Results: During the 17-year period, 179,887 trauma patients were admitted to a regional trauma center in Korea. Of these patients, 74 (0.04%) had duodenal injuries. A total of 49 consecutive patients had grade 2 and 3 traumatic duodenal injuries and underwent laparotomy. The incidence of postoperative leakage was 32.6% (16/49). Overall mortality was 18.4% (9/49). A stepwise multivariable logistic regression and LASSO logistic regression model showed that time from injury to initial operation was the sole statistically significant risk factor. The ROC curve at the optimal threshold of 15.77 h showed the following: area under ROC curve, 0.782; sensitivity, 68.8%; specificity, 87.9%; positive predictive value, 73.3%; and negative predictive value, 85.3%. There was no significant difference in outcomes between primary repair alone and pyloric exclusion. Conclusions: Time from injury to initial operation may be the sole significant risk factor for postoperative duodenal leakage. Pyloric exclusion may not be able to prevent postoperative leakage. [ABSTRACT FROM AUTHOR]

Abstract Background This study describes the successful treatment of two clinical settings of grade V pancreaticoduodenal blunt trauma only possible due to the prompt collaboration of a peripheral trauma hospital and a central hepatobiliary and pancreatic unit. Case presentation We reviewed the clinical records of two male patients aged 17 and 47 years old who underwent a two-stage pancreaticoduodenectomy after a previous Damage-Control Surgery (DCS). Both patients were transferred to our Hepatobiliopancreatic Unit 2 days after immediate DCS with haemostasis, debridement, duodenostomy, gastroenterostomy, external drainage and laparostomy. One day after, they both underwent a two-stage Whipple’s procedure with external cannulation of the main bile duct and the main pancreatic duct with seized calibre silicone drains through the skin. The reconstructive phase was performed two weeks later. The first patient had an uneventful post-operative course and was discharged on post-operative day 8. The second patient developed a high debt biliary fistula on post-operative day 5 being submitted to a relaparotomy with extensive peritoneal lavage. After conservative measures the fistula underwent a progressive closure in 15 days, and the patient was discharged at post-operative day 50 without any limitations. Conclusions Pancreaticoduodenectomy is a life-saving operation in selected grade V pancreaticoduodenal trauma lesions. DCS is a salvage approach, often performed in peripheral hospitals, making an early referral to an hepatobiliopancreatic centre mandatory to achieve survival in these severely injured patients. A two-staged Whipple’s operation for severe duodenal / pancreatic trauma can be performed safely and may represent a life-saving option under these very unusual circumstances.

Introduction: Pancreaticoduodenectomy is a complex surgical procedure with significant potential for complications such as pancreatic fistula, bile leakage, intra-abdominal abscesses, and hemorrhage. Emergency pancreaticoduodenectomy (EPD) performed for traumatic injuries carries even greater risks due to the patient's severely unstable condition upon admission. While the literature recommends that EPD be reserved for hemodynamically stable trauma patients, there are scenarios where it may be the last resort to save the patient's life., Case Presentation: A 49-year-old male presented in the emergency department after a collision with a truck. He sustained extensive pancreaticoduodenal deconstruction combined with IVC, liver, right kidney, and right adrenal injuries following blunt abdominal trauma. Despite the patient's hemodynamic instability, the surgical team proceeded with EPD combined with IVC repair, right nephrectomy, adrenalectomy, cholecystectomy, and liver hemostasis. Postoperative complications included biliary leakage and intraabdominal abscess, all of which were successfully conservatively managed., Clinical Discussion: Upon entering the abdomen, the priority was rapid identification and control of the significant bleeding, particularly from the injured IVC. While additional procedures like nephrectomy and adrenalectomy were required, continued bleeding from the crushed pancreatic head left EPD as the only viable option to save the patient., Conclusion: EPD can be a lifesaving procedure for a small portion of trauma patients with non-reconstructable pancreaticoduodenal injury, even in the setting of hemodynamic instability. However, it should only be performed at high-volume centers and by experienced hepato-pancreato-biliary surgeons., Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: Traumatic duodenal injury is a rare disease with limited evidence. We aimed to evaluate the risk factors for postoperative leakage and outcomes of pyloric exclusion after duodenal grade 2 and 3 injury. Materials and Methods: We reviewed a prospectively collected trauma database for the period January 2004–December 2020. Patients with grade 2 and 3 traumatic duodenal injury were included. To identify the risk factors for postoperative leakage, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) logistic model. We constructed a receiver operator characteristic (ROC) curve to predict risk factors for postoperative leakage. Results: During the 17-year period, 179,887 trauma patients were admitted to a regional trauma center in Korea. Of these patients, 74 (0.04%) had duodenal injuries. A total of 49 consecutive patients had grade 2 and 3 traumatic duodenal injuries and underwent laparotomy. The incidence of postoperative leakage was 32.6% (16/49). Overall mortality was 18.4% (9/49). A stepwise multivariable logistic regression and LASSO logistic regression model showed that time from injury to initial operation was the sole statistically significant risk factor. The ROC curve at the optimal threshold of 15.77 h showed the following: area under ROC curve, 0.782; sensitivity, 68.8%; specificity, 87.9%; positive predictive value, 73.3%; and negative predictive value, 85.3%. There was no significant difference in outcomes between primary repair alone and pyloric exclusion. Conclusions: Time from injury to initial operation may be the sole significant risk factor for postoperative duodenal leakage. Pyloric exclusion may not be able to prevent postoperative leakage.

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.

Background: This study describes the successful treatment of two clinical settings of grade V pancreaticoduodenal blunt trauma only possible due to the prompt collaboration of a peripheral trauma hospital and a central hepatobiliary and pancreatic unit.Case Presentation: We reviewed the clinical records of two male patients aged 17 and 47 years old who underwent a two-stage pancreaticoduodenectomy after a previous Damage-Control Surgery (DCS). Both patients were transferred to our Hepatobiliopancreatic Unit 2 days after immediate DCS with haemostasis, debridement, duodenostomy, gastroenterostomy, external drainage and laparostomy. One day after, they both underwent a two-stage Whipple's procedure with external cannulation of the main bile duct and the main pancreatic duct with seized calibre silicone drains through the skin. The reconstructive phase was performed two weeks later. The first patient had an uneventful post-operative course and was discharged on post-operative day 8. The second patient developed a high debt biliary fistula on post-operative day 5 being submitted to a relaparotomy with extensive peritoneal lavage. After conservative measures the fistula underwent a progressive closure in 15 days, and the patient was discharged at post-operative day 50 without any limitations.Conclusions: Pancreaticoduodenectomy is a life-saving operation in selected grade V pancreaticoduodenal trauma lesions. DCS is a salvage approach, often performed in peripheral hospitals, making an early referral to an hepatobiliopancreatic centre mandatory to achieve survival in these severely injured patients. A two-staged Whipple's operation for severe duodenal / pancreatic trauma can be performed safely and may represent a life-saving option under these very unusual circumstances. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center.Methods: We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.1.0.Results: 170 children presented with pancreatic and/or duodenal injury. 13 (7.7%) suffered a combined injury and this group forms the basis for this report with mean ISS of 22.8 (± 15.1), RTS2 of 6.4(± 2.1), and median age of 6.6 (1.3-13.5) years. Child abuse (31%) and bicycle injuries (23%) were the most common mechanisms. 8/13 (61.5%) required operative intervention. Higher AAST pancreatic and duodenal injury grade (2.9 vs. 1.2, p = 0.05 and 3.6 vs. 1.4, p = < 0.01), lower RTS2 (7.84 vs. 5.49, p < 0.01), and lower GCS (9.6 vs. 15, p = 0.03) predicted operative intervention. 6/8 (75%) undergoing surgery survived to discharge with only (2/6) survivors suffering postoperative complications. Both mortalities were secondary to severe traumatic brain injury.Conclusion: Surgical management of complex pancreaticoduodenal injury is an uncommon traumatic event that is associated with high injury severity, but survival occurs in most scenarios. [ABSTRACT FROM AUTHOR]

Duodenal trauma resulting in perforation is rare and management can be challenging due to injuries in other organs and vascular structures. Primary repair is the preferred option and is technically feasible even in cases with large defects. In more complex injuries with pancreaticobiliary tract involvement, damage control techniques and staged procedures may be required. Triple tube drainage with tube gastrostomy, tube duodenostomy, and feeding jejunostomy can benefit the adequate decompression of the duodenum and protect the primary repair suture line. We report the case of a 35-year-old male patient with perforation in the second part of the duodenum following a gunshot injury, who was managed with primary repair and triple tube drainage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Karveli et al.)

Injury to duodenum and pancreas is rare because of there safe retroperitoneal anatomical position. The injury to duodenum and pancreas initially present little symptoms therefore both pre and intra-operative detection of injury can be difficult. Also majority of the Pancreaticoduodenal injuries although are very rare but have a significant morbidity and mortality. Both Duodenum and pancreas have safe retro-peritoneal location, therefore sign and symptoms patients are subtle therefore difficult to diagnose also these patients have multiple associated injuries and are hemodynamically unstable which can be a cause of early mortality in these cases. We present case report of 23 years old male who presented to a peripheral Hospital with a history of gunshot abdomen with wound of entry in epigastrium and wound of exit on right site of abdomen posteriorly, he underwent laparotomy at peripheral hospital, the findings documented at laparotomy was 8 cms tear in right lobe of liver, two tears were found in transverse colon which were repaired and proximal colon was brought out as loop colostomy. Two drains were placed in morrisons pouch and pelvis. Patient was referred to King Abdullah Hospital Bisha as patient was discharging copious biliary fluid in both drains. The Patient was resuscitated and underwent CT abdomen with Gastrografin oral contrast which was suggestive of Duodenal tear at the second and 3rd part of Duodenum which was repaired in 2 layers with Nasogastric tube placed, tube gastrostomy and feeding Jejunostomy performed. Patient had an uneventful recovery. Oral fluid started on 6th post-operative day. And tube gastrostomy was removed on 10th post-operative day. Conclusion: Duodenal injuries are rare due to safe anatomical position of Duodenum. The clinician should have high index of suspision when ever he is dealing with road traffic accident, seat belt injuries and gunshot abdomen to diagnose such injury, so that timely treatment can be off ered to patient to avoid morbidity and mortality. [ABSTRACT FROM AUTHOR]

Conservative treatment of duodenal trauma in children has long been the first line of treatment for duodenal wall hematomas. However, it has rarely been described in duodenal perforations. Our purpose is to highlight the possibility of conservative treatment in selected cases of duodenal perforation. In the period between 2009 and 2022, 6 children were treated for duodenal injury following abdominal blunt trauma in the pediatric surgical emergency department. The clinical presentation, diagnosis and treatment are reported and analyzed. Three patients presented with duodenal hematomas, they were treated non-operatively with hospital stays between 12 and 20 days and good clinical outcome. One child presented with duodenal hematoma and retroperitoneal air bubbles; non-operative conservative treatment was carried with favorable results. The fifth patient had a duodenal perforation; he underwent a primary duodenal 2-layers closure. The last patient had a combination of duodenal hematoma and perforation involving 75% of the duodenal diameter for which he underwent a gastro-jejunostomy with pyloric exclusion. An isolated duodenal lesion can be subject to a conservative treatment whenever allowed by a stable clinical condition and the availability of appropriate clinical and radiological monitoring., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Introduction During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits. Presentation of the case A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently. Discussion During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage. Conclusion In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children. Methods: We searched 12 databases, with snowballing techniques, for the period 1950–2011, with all identified studies undergoing two independent reviews by trained reviewers, drawn from pediatrics, radiology, pediatric surgery and pathology. Of 5802 studies identified, 188 were reviewed. We included studies of children aged 0–18, with confirmed abusive etiology, whose injury was defined by computed tomography, contrast studies or at surgery/post mortem. We excluded injuries due to sexual abuse, or those exclusively addressing management or outcome. Results: Of 88 included studies (64 addressing abdominal injuries), only five were comparative. Every organ in the body has been injured, intra-thoracic injuries were commoner in those aged less than five years. Children with abusive abdominal injuries were younger (2.5–3.7 years vs. 7.6–10.3 years) than accidentally injured children. Duodenal injuries were commonly recorded in abused children, particularly involving the third or fourth part, and were not reported in accidentally injured children less than four years old. Liver and pancreatic injuries were frequently recorded, with potential pancreatic pseudocyst formation. Abdominal bruising was absent in up to 80% of those with abdominal injuries, and co-existent injuries included fractures, burns and head injury. Post mortem studies revealed that a number of the children had sustained previous, unrecognized, abdominal injuries. The mortality from abusive abdominal injuries was significantly higher than accidental injuries (53% vs. 21%). Only three studies addressed screening for abdominal injury among abused children, and were unsuitable for meta-analysis due to lack of standardized investigations, in particular those with ‘negative’ screening tests were not consistently investigated. Conclusions: Visceral injuries may affect any organ of the body, predominantly abdominal viscera. A non-motor vehicle related duodenal trauma in a child aged

Background/purpose: Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high. Methods: The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed. Results: In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team. Conclusions: Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to share our surgical experience of duodenal injuries in past 3 years and to evaluate outcome different surgical approaches. Patients and Method: 32 consecutive patients diagnosed with traumatic duodenal injuries admitted to CMCTH during 3 years period from March 2007 to February 2010 were retrospectively analyzed. The data collected on study specific Proforma included demographic data, cause of injury, number and size of injury, anatomic location of duodenal injury, grade of duodenal injury, surgical procedures performed, morbidity and mortality. Results: During the period under study a total of 32 consecutive patients with duodenal injuries were included in the study. There were 29 (90.6%) male and 3 (9.4%) female with male to female ratio of 9:1 and mean age of 27.8 years. 78.12% cases were due to penetrating injuries predominantly firearm injuries and 22.98% were due to blunt trauma. second part of duodenum was found to be the most commonly injured site in 53% case and grade III injuries accounted for 53% of total injuries. Two of the three female patients having the associated injuries to pelvic organs like uterus were, managed with gynecologist. Note: The most common operative procedure performed was primary repair with and without Tube Duodenostomy. Post-operatively 6.25% cases developed duodenal fistula, and the overall morbidity was found to be 34.37% and mortality 28%. Conclusion: The duodenal trauma is an uncommon injury associated with the significant morbidity and mortality. Their detection can be challenging due to the retroperitoneal location. Exploratory laparotomy remains as the ultimate diagnostic test, even in the face of absent or equivocal radiographic signs. Treatment of injured duodenum varies, according to severity of injury, degree of contamination of the peritoneal cavity, associated organs injury and duration before diagnosis. Therefore early diagnosis and appropriate surgical repair are the keys to good outcome and improved survival. [ABSTRACT FROM AUTHOR]

Background. Duodenal trauma is non-frequent, intimidating for surgeons. Primary duodenorrhaphy is feasible in 85% of cases; however, a group denominated "complex duodenal trauma" -- combined pancreaticoduodenal trauma, blunt trauma, gunshot wound to duodenum, laceration of > 75% of duodenal circumference; injury to D1-D2 regardless associated biliar trauma and associated abdominal vascular injury -- exists, and the instauration of other techniques is mandatory. The Organ Injury Scale from the American Association for the Surgery of Trauma (AAST-OIS) does not define the need of a particular surgical strategy. The objective of this manuscript is to evaluate whether statistically validated anatomical indicators, trauma mechanisms or predictive factors demand a specific surgical technique. Material and methods. Bibliographic/electronic research and stratification of data from case reports, cases series and clinical series related to duodenal trauma from MED LINE, IMBIOMED, MEDIGRAPHIC and HELLIS, Statistical analysis: univariate analysis and Spearman's rank-correlation index. Results. On the basis of 93 manuscripts over a 39-years span, 3,345 cases of duodenal trauma were included. Penetrating trauma was present in 84.4% of cases and blunt trauma in 15.6%. Primary duodenorrhaphy was practiced in 65.7% of cases and complex techniques in 34.2%. Most common complex technique was resection/anastomosis (44.5%). In univariate analysis, penetrating trauma was significantly related to resection/anastomosis. Conclusions. Although is possible to associate some clinical settings with specific surgical techniques, it is not possible to validate reliable indicators to institute a particular surgical strategy in cases of complex duodenal trauma. Systematic approach reported by Asensio, strict adherence to AAST-OIS graduation system and thorough investigation of injury severity, associated injuries and hemodynamic stability are mandatory for making decisions. Currently, clinical experience remains as the corner-stone for selecting optimal treatment. [ABSTRACT FROM AUTHOR]

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment. [ABSTRACT FROM AUTHOR]

Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes. [ABSTRACT FROM AUTHOR]

There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment., (Copyright: © 2019 Permanyer.)

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion., Competing Interests: No conflict of interest was declared by the authors.

A 3-year-old male was beaten by his stepfather, resulting in a lesion of the third portion of the duodenum that was treated with an occlusive suture of the pyloric mucosa for pyloric exclusion and a gastric-jejunal anastomosis with a double jejunostomy for alimentation with a good result, no serious complications, and relatively a short hospitalization. This procedure may be an alternative for other similar cases. [ABSTRACT FROM AUTHOR]

Introduction: During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits., Presentation of the Case: A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently., Discussion: During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage., Conclusion: In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases.