Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1975 Jan;181(1):92–98. doi: 10.1097/00000658-197501000-00020

Traumatic injuries to the duodenum: a report of 98 patients.

R D Corley, W J Norcross, W C Shoemaker
PMCID: PMC1343722  PMID: 1119875

Abstract

Data of 98 patients who had sustained traumatic injuries to the duodenum during a recent 7-year period is reviewed. The overall mortality was 23.5%; that of the blunt injury group was 35%, that of the penetrating injury group was 20%. However, after the establishment of a trauma unit, the mortality for duodenal injuries fell from 32% to 12%. Death from duodenal wounds may be reduced by earlier hospitalization, earlier diagnosis and consequently earlier surgical repair. Vigorous treatment of shock is essential. A specialized trauma unit with personnel experienced in the management of shock and trauma problems provides a better environment to carry out the preoperative and postoperative care of the acutely injured patient. Adequate surgical treatment of the blunt injury and missile injury of the duodenum should consist of the following procedures: 1) repair of the duodenal wall utilizing conventional techniques; 2) internal decompression of the repair by afferent jejunostomy; 3) efferent jejunostomy for postoperative feeding; 4) temporary gastrostomy; and 5) external drainage of the repair. In certain selected instances, the simple stab wound of the duodenum may be treated by conventional repair without decompression, but a loop of jujunum should be sutured over the repair to prevent delayed disruption. The majority of patients with injuries to the duodenum have associated organs injured which also require considered surgical judgment and action.

Full text

PDF
93

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BURRUS G. R., HOWELL J. F., JORDAN G. L., Jr Traumatic duodenal injuries: an analysis of 86 cases. J Trauma. 1961 Mar;1:96–104. [PubMed] [Google Scholar]
  2. Brawley R. K., Cameron J. L., Zuidema G. D. Severe upper abdominal injuries treated by pancreaticoduodenectomy. Surg Gynecol Obstet. 1968 Mar;126(3):516–522. [PubMed] [Google Scholar]
  3. CLEVELAND H. C., WADDELL W. R. Retroperitoneal rupture of the duodenum due to nonpenetrating trauma. Surg Clin North Am. 1963 Apr;43:413–431. doi: 10.1016/s0039-6109(16)36936-5. [DOI] [PubMed] [Google Scholar]
  4. COCKE W. M., Jr, MEYER K. K. RETROPERITONEAL DUODENAL RUPTURE. PROPOSED MECHANISM, REVIEW OF LITERATURE AND REPORT OF A CASE. Am J Surg. 1964 Dec;108:834–839. doi: 10.1016/0002-9610(64)90043-1. [DOI] [PubMed] [Google Scholar]
  5. Cegielski M. Rupture of the duodenum in blunt abdominal trauma. Mo Med. 1965 Nov;62(11):903–908. [PubMed] [Google Scholar]
  6. Colp R. EXTERNAL DUODENAL FISTULAE. Ann Surg. 1923 Dec;78(6):725–744. doi: 10.1097/00000658-192312000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Morton J. R., Jordan G. L., Jr Traumatic duodenal injuries. Review of 131 cases. J Trauma. 1968 Mar;8(2):127–139. [PubMed] [Google Scholar]
  8. Shoemaker W. C., Elwyn D. H., Rosen A. L. Development and goals of a trauma and shock research center. J Mt Sinai Hosp N Y. 1968 Sep-Oct;35(5):451–472. [PubMed] [Google Scholar]
  9. Shoemaker W. C., Printen K. J., Amato J. J., Monson D. O., Carey J. S., O'Connor K. Hemodynamic patterns after acute anesthetized and unanesthetized trauma. Evaluation of the sequence of changes in cardiac output and derived calculations. Arch Surg. 1967 Sep;95(3):492–499. doi: 10.1001/archsurg.1967.01330150168021. [DOI] [PubMed] [Google Scholar]
  10. Summers J. E. IX. The Treatment of Posterior Perforations of the Fixed Portions of the Duodenum. Ann Surg. 1904 May;39(5):727–732. doi: 10.1097/00000658-190405000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. WEBB H. W., HOWARD J. M., JORDAN G. L., VOWLES K. D. Surgical experiences in the treatment of duodenal injuries. Surg Gynecol Obstet. 1958 Feb;106(2):105–114. [PubMed] [Google Scholar]
  12. WOLFF L. H., GIDDINGS W. P. Penetrating wounds of the stomach, duodenum and small intestine. Surg Clin North Am. 1958 Dec;38(6):1605–1618. doi: 10.1016/s0039-6109(16)35640-7. [DOI] [PubMed] [Google Scholar]
  13. Webb A. J., Taylor J. J. Traumatic intramural haematoma of the duodenum. Br J Surg. 1967 Jan;54(1):50–56. doi: 10.1002/bjs.1800540113. [DOI] [PubMed] [Google Scholar]
  14. Wolfer J. A. JEJUNOSTOMY WITH JEJUNAL ALIMENTATION. Ann Surg. 1935 Feb;101(2):708–725. doi: 10.1097/00000658-193502000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES