We reviewed 28 cases of the traumatic duodenal wounds treated at Department of general surgery. Presbyterian Medical Center during recent 15 years and obtained following results.
1) There were 25 blunt injuries (89%) and 3 penetrating injuries(11%).
2) The second portion of duodenum was the most common injury site in 10 cases(35.7%), the first portion in 3 cases, the third portion in 7-cases, and the fourth portion in 6 cases.
Two cases had combined injuries which involved more than two portions.
3) The most common diagnostic method was the plain abdomen film with the right subhepatic free air in 8 cases.
Peritoneal lavage and abdominal CT were other helpful diagnostic methods in 5 cases and 4 cases, respectively.
4) The operative intervention was carried out within 6 hours after the injury in 12 cases (43%) and the complications developed in 4 cases(33.3%), and carried out in 16 cases (57%) over 6 hours and the complications developed in 10 cases
(62.5%).
5) Kocher's maneuver for evaluation of the duodenal injuries was performed in 23 cases and then the morbidity was 47.8% and the mortality was 4.3%, while in 5 cases without performance of Kocher's maneuver, then 100% and 40%, respectively.
6) Associated injuries were noted in 22 cases.
The most frequent associated injured organ was pancreas; 11 cases(89.2%). Two organ-associated injury: 4 cases.
More than 3 organ-associated injury; 4 cases.
7) The operative methods were as followed.
Drainage only in 5 cases.
Duodenorrhaphy with or without tube decompression in 9 cases.
Resection and anastomosis in 3 cases.
Duodenorrhaphy with other decompressive procedure in 8 cases.
And, pancreaticoduodenectomy in 3 cases.
8) Among the 16 cases performed tube decompression, duodenal fistula developed in 4 cases (25%), while in 7 cases without tube decompression, duodenal fistula developed in 4 cases (57.1%).
9) The most common postoperative complication was the pulmonary complication in 10 cases. The second was wound infection in 9 cases, and the third, fistula in 8 cases.
Intestinal obstruction, gastrointestinal hemorrhage, pancreatitis, and intraabdominal abscess were followed.
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