RU Hao , KUO Wenlei , LIU Chang , DONG Zepeng , SUN Xuejun , SUN Qi
  • Department of General Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, P. R. China;
SUN Qi, Email: sunqi4875@163.com
Blunt abdominal trauma; duodenal injury; surgery
10.7507/1002-0179.202409198
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Objective  To investigate the surgical treatment and outcomes for duodenal injury in blunt abdominal trauma. Methods  Clinical data of patients with traumatic duodenal injury who underwent surgical treatment in the First Affiliated Hospital of Xi’an Jiaotong University between December 2014 and August 2023 were retrospectively collected. The injury causes, diagnostic methods, surgical treatment methods, curative effect, and complications of patients were analyzed. Results  A total of 8 patients were included. Among them, there were 7 males and 1 female; The age ranged from 17 to 66 years old, with an average of (44.4±19.3) years old; 5 cases of traffic accident injury, 2 cases of crush injury, and 1 case of falling injury; There were 1 case in the duodenal bulb injury, 3 cases in the descending part injury, 3 cases in the horizontal part injury and 1 case of both descending and horizontal injuries. According to the scale of American Association for the Surgery of Trauma for pancreatic trauma, there were 5 cases of grade Ⅱ injury, 2 cases of grade Ⅲ injury, and 1 case of grade Ⅳ injury. All patients underwent CT scan, of which two cases were directly diagnosed with duodenal injuries by CT, and the remaining cases diagnosed by intraoperative exploration. All patients underwent surgical treatment, including 4 cases of pancreaticoduodenectomy, 2 cases of duodenal repair and gastrojejunostomy, 1 case of duodenal repair plus jejunostomy, and 1 case of superior mesenteric vein repair, pancreatic necrotic tissue removal, and abdominal catheterization for smooth drainage. One patient developed duodenal fistula on the ninth day after surgery and received secondary surgery, 1 died of multiple organ failure during the resuscitation phase after damage control surgery, 3 developed intra-abdominal infection and cured by anti-infective treatment. Conclusions  Early clinical manifestations of traumatic duodenal injuries are atypical, and imaging findings might not be clear. For trauma patients suspected of having duodenal injury, rigorous vital sign monitoring is necessary. Once vital signs stabilize, exploratory surgery should be actively considered to identify the location of the injury and perform appropriate surgical procedures. Postoperatively, adequate postoperative enteric decompression and drainage should be ensured.