Duodenal trauma: Experience of a trauma center

Marc A. Levison, Scott R. Petersen, George F. Sheldon, Donald Trunkey

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

In the past decade 93 patients with deodenal injury were treated at a trauma center. By chart review, the age, sex, mechanism of injury, time to initial exploration (and the reason for delay), laboratory results, associated injury, extent of deodenal injury, operative repair, use of drains and tube decompression, morbidity, and cause of death were tabulated in order to improve management of these injuries. Of 87 patients surviving until the time of operative repair 73% required no repair (four) or primary closure (59). The remainder had either resection with primary anastomosis (ten), diverticulization (12), or pancreaticoduodenectomy (two). All patients with penetrating trauma were immediately explored. Patients with blunt trauma were explored on the basis of the judgment of house staff and faculty. Overall mortality was 18%. Significant morbidity occurred in 49% of survivors. This urban experience was heavily weighted toward penetrating injury. In this group early death usually resulted from associated vascular injuries. Blunt duodenal injury was less frequently associated with immediate exsanguination. Mortality associated with blunt duodenal injury was usually the result of delayed diagnosis. In blunt duodenal trauma peritoneal lavage is not diagnostic and may often be misleading; in this series 50% of lavages were false negatives. Blunt duodenal trauma, particularly when combined with pancreatic injury or delayed repair, was a lethal combination. A high index of suspicion and aggressive diagnostic evaluation (CT contrast study/amylase) in the emergency department is required in equivocal cases to avoid morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)475-480
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume24
Issue number6
StatePublished - 1984
Externally publishedYes

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Trauma Centers
Wounds and Injuries
Nonpenetrating Wounds
Morbidity
Mortality
Exsanguination
Peritoneal Lavage
Pancreaticoduodenectomy
Vascular System Injuries
Delayed Diagnosis
Therapeutic Irrigation
Amylases
Internship and Residency
Operative Time
Decompression
Survivors
Hospital Emergency Service
Cause of Death

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Duodenal trauma : Experience of a trauma center. / Levison, Marc A.; Petersen, Scott R.; Sheldon, George F.; Trunkey, Donald.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 24, No. 6, 1984, p. 475-480.

Research output: Contribution to journalArticle

Levison, MA, Petersen, SR, Sheldon, GF & Trunkey, D 1984, 'Duodenal trauma: Experience of a trauma center', Journal of Trauma - Injury, Infection and Critical Care, vol. 24, no. 6, pp. 475-480.
Levison, Marc A. ; Petersen, Scott R. ; Sheldon, George F. ; Trunkey, Donald. / Duodenal trauma : Experience of a trauma center. In: Journal of Trauma - Injury, Infection and Critical Care. 1984 ; Vol. 24, No. 6. pp. 475-480.
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