Conservative management of duodenal trauma

A multicenter perspective

Thomas H. Cogbill, Ernest E. Moore, David V. Feliciano, David B. Hoyt, Gregory J. Jurkovich, John A. Morris, Peter Mucha, Steven E. Ross, Pamela J. Strutt, Frederick A. Moore, Vicky Spjut-Patrinely, Mark G. Tellez, Patrick J. Offner, Todd Wilcox, Michael B. Farnell, Keith F. O'Malley

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

The experience of eight trauma centers with duodenal injuries was analyzed to identify trends in operative management, sources of duodenal-related morbidity, and causes of mortality. During the 5-year period ending December 1988, 164 duodenal injuries were identified. Patient ages ranged from 5 to 78 years. There were 38 Class I, 70 Class II, 48 Class III, four Class IV, and four Class V injuries. Injury mechanism was penetrating in 102 (62%) patients and blunt in 62. Primary repair of the duodenal injury was performed in 117 (71%) patients, including 27 patients also managed with pyloric exclusion and 12 with tube duodenostomy. Duodenal resection with primary anastomosis was used in six (4%) patients and pancreatoduodenectomy was necessary in five (3%). There were 30 (18%) deaths. The cause of death was uncontrolled hemorrhage from severe hepatic or vascular injuries in 22 (73%) patients. In only two (1%) patients could death be attributed to the duodenal injury; each as the result of duodenal repair dehiscence and subsequent sepsis. Duodenal-related morbidity was documented in 29 (18%) patients, including 22 patients with intra-abdominal abscess, six with duodenal fistula, and five with frank duodenal dehiscence. In summary, this analysis demonstrated: 1) the great majority of duodenal injuries can be managed by simple repair; 2) tube duodenostomy is not a mandatory component of operative treatment; 3) pyloric exclusion is a useful adjunct for more complex injuries; 4) pancreatoduodenectomy is rarely necessary for civilian duodenal trauma; 5) morbidity following duodenal trauma is more dependent on associated intra-abdominal injuries than the extent of duodenal trauma; and 6) mortality following duodenal injuries is primarily related to associated vascular and hepatic trauma.

Original languageEnglish (US)
Pages (from-to)1469-1475
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume30
Issue number12
DOIs
StatePublished - Jan 1 1990

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Wounds and Injuries
Duodenostomy
Pancreaticoduodenectomy
Morbidity
Conservative Treatment
Abdominal Abscess
Abdominal Injuries
Mortality
Trauma Centers
Liver
Vascular System Injuries
Fistula
Blood Vessels
Cause of Death
Sepsis
Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Conservative management of duodenal trauma : A multicenter perspective. / Cogbill, Thomas H.; Moore, Ernest E.; Feliciano, David V.; Hoyt, David B.; Jurkovich, Gregory J.; Morris, John A.; Mucha, Peter; Ross, Steven E.; Strutt, Pamela J.; Moore, Frederick A.; Spjut-Patrinely, Vicky; Tellez, Mark G.; Offner, Patrick J.; Wilcox, Todd; Farnell, Michael B.; O'Malley, Keith F.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 30, No. 12, 01.01.1990, p. 1469-1475.

Research output: Contribution to journalArticle

Cogbill, TH, Moore, EE, Feliciano, DV, Hoyt, DB, Jurkovich, GJ, Morris, JA, Mucha, P, Ross, SE, Strutt, PJ, Moore, FA, Spjut-Patrinely, V, Tellez, MG, Offner, PJ, Wilcox, T, Farnell, MB & O'Malley, KF 1990, 'Conservative management of duodenal trauma: A multicenter perspective', Journal of Trauma - Injury, Infection and Critical Care, vol. 30, no. 12, pp. 1469-1475. https://doi.org/10.1097/00005373-199012000-00005
Cogbill, Thomas H. ; Moore, Ernest E. ; Feliciano, David V. ; Hoyt, David B. ; Jurkovich, Gregory J. ; Morris, John A. ; Mucha, Peter ; Ross, Steven E. ; Strutt, Pamela J. ; Moore, Frederick A. ; Spjut-Patrinely, Vicky ; Tellez, Mark G. ; Offner, Patrick J. ; Wilcox, Todd ; Farnell, Michael B. ; O'Malley, Keith F. / Conservative management of duodenal trauma : A multicenter perspective. In: Journal of Trauma - Injury, Infection and Critical Care. 1990 ; Vol. 30, No. 12. pp. 1469-1475.
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abstract = "The experience of eight trauma centers with duodenal injuries was analyzed to identify trends in operative management, sources of duodenal-related morbidity, and causes of mortality. During the 5-year period ending December 1988, 164 duodenal injuries were identified. Patient ages ranged from 5 to 78 years. There were 38 Class I, 70 Class II, 48 Class III, four Class IV, and four Class V injuries. Injury mechanism was penetrating in 102 (62{\%}) patients and blunt in 62. Primary repair of the duodenal injury was performed in 117 (71{\%}) patients, including 27 patients also managed with pyloric exclusion and 12 with tube duodenostomy. Duodenal resection with primary anastomosis was used in six (4{\%}) patients and pancreatoduodenectomy was necessary in five (3{\%}). There were 30 (18{\%}) deaths. The cause of death was uncontrolled hemorrhage from severe hepatic or vascular injuries in 22 (73{\%}) patients. In only two (1{\%}) patients could death be attributed to the duodenal injury; each as the result of duodenal repair dehiscence and subsequent sepsis. Duodenal-related morbidity was documented in 29 (18{\%}) patients, including 22 patients with intra-abdominal abscess, six with duodenal fistula, and five with frank duodenal dehiscence. In summary, this analysis demonstrated: 1) the great majority of duodenal injuries can be managed by simple repair; 2) tube duodenostomy is not a mandatory component of operative treatment; 3) pyloric exclusion is a useful adjunct for more complex injuries; 4) pancreatoduodenectomy is rarely necessary for civilian duodenal trauma; 5) morbidity following duodenal trauma is more dependent on associated intra-abdominal injuries than the extent of duodenal trauma; and 6) mortality following duodenal injuries is primarily related to associated vascular and hepatic trauma.",
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AU - Cogbill, Thomas H.

AU - Moore, Ernest E.

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AU - Jurkovich, Gregory J.

AU - Morris, John A.

AU - Mucha, Peter

AU - Ross, Steven E.

AU - Strutt, Pamela J.

AU - Moore, Frederick A.

AU - Spjut-Patrinely, Vicky

AU - Tellez, Mark G.

AU - Offner, Patrick J.

AU - Wilcox, Todd

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AU - O'Malley, Keith F.

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N2 - The experience of eight trauma centers with duodenal injuries was analyzed to identify trends in operative management, sources of duodenal-related morbidity, and causes of mortality. During the 5-year period ending December 1988, 164 duodenal injuries were identified. Patient ages ranged from 5 to 78 years. There were 38 Class I, 70 Class II, 48 Class III, four Class IV, and four Class V injuries. Injury mechanism was penetrating in 102 (62%) patients and blunt in 62. Primary repair of the duodenal injury was performed in 117 (71%) patients, including 27 patients also managed with pyloric exclusion and 12 with tube duodenostomy. Duodenal resection with primary anastomosis was used in six (4%) patients and pancreatoduodenectomy was necessary in five (3%). There were 30 (18%) deaths. The cause of death was uncontrolled hemorrhage from severe hepatic or vascular injuries in 22 (73%) patients. In only two (1%) patients could death be attributed to the duodenal injury; each as the result of duodenal repair dehiscence and subsequent sepsis. Duodenal-related morbidity was documented in 29 (18%) patients, including 22 patients with intra-abdominal abscess, six with duodenal fistula, and five with frank duodenal dehiscence. In summary, this analysis demonstrated: 1) the great majority of duodenal injuries can be managed by simple repair; 2) tube duodenostomy is not a mandatory component of operative treatment; 3) pyloric exclusion is a useful adjunct for more complex injuries; 4) pancreatoduodenectomy is rarely necessary for civilian duodenal trauma; 5) morbidity following duodenal trauma is more dependent on associated intra-abdominal injuries than the extent of duodenal trauma; and 6) mortality following duodenal injuries is primarily related to associated vascular and hepatic trauma.

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