From January, 1985 to December, 1990, nineteen patients with traumatic duodenal injuries were surgically treated at Pohang St. Mary's Hospital. By chart review, the age. Sex, mechanism of injury, time of injury, time of exploration, diagnostic
method,
associated injury, site and type of injury, operative treatment. mobidity and motality were tabulated in order to improve management of these injuries.
Duodenal injuries occurred in 7.3% of patients sustaining intra-abdominal injuries. Seventeen blunt injuries (80.4%) and two penetating injuries (19.6%) were encountered. Blunt injuries were usually the result of motor vehicle accidents(10). The
two
penetrating injuries followed stab wounds.
57% of the patients had one or more associated intra-abdominal organ injuries with other intestinal injuries(4). Hepatobiliary injuries(3), pancreas injuries(6), and major vascular injuries.
The abdominal radiographs and upright chest showed intra-abdominal air nd retroperitoneal air in 3 cases. The contrast gastroduodenography and abdominal CT scan showed gastrograffin leakage at perforation site in 3 cases. The peritoneal
paracentesis was
valuable in 5 patients with equivocal physical findings.
Technique for operative repair included bleeing control and simple closure(8), segmental resection with duodeno-jejunostomy(5), diverticulization(3), simple colsure and antrectomy with gastro-jejunostomy(2), and hematoma removal(1). The tube
decompression of duodenum was valuable addition.
The overall motality was .3%(1 of 19) and the cause of death was sepsis, result of delayed diagnosis. The duodenal complications occurring in the seven patients included duodenal fistulas (5) and intra-abdominal abscess formation(2). A high index
of
suspicion and aggressive diagnostic studies when evaluating patients after blows to the upper abdomen or with penetrating wounds in the right upper quadrant is required.
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