Advertisement

Traumatic Injury of the Duodenum and Pancreas: How to Approach a Rare Injury

  • Maria Tsachiridi
  • Alexandros Bougkas
  • Ioannis Stavrakis
Surgery
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on Surgery

Abstract

In this article, we present our experience of trauma of the upper abdomen, mainly the duodenum and pancreas, and the challenges that we faced during pre-, intra-, and postoperative management of these patients. We also discuss the implementation of the techniques described in literature in the everyday practice. Four cases of trauma of the upper abdomen presented to our hospital and treated by our team are discussed. We present the technique implemented, the postoperative management, as well as dealing with complications. A brief review of literature is conducted to identify the best approach to diagnosis, imaging, and operating techniques. Abdominal blunt and penetrating injury poses a challenge to every trauma surgeon. These injuries are distinguished by their severity and unpredictability of intraoperative findings, as well as the difficulty of their management. The extent of the operation is dictated by the severity of the injury and the complexity of the technique should be proportionate to the experience of the surgeon. The most complicated cases might require additional techniques, procedures, or referral to a specialized center.

Keywords

Duodenal injury Pancreatic injury Abdominal trauma Trauma surgery 

Notes

Compliance with Ethical Standards

Informed Consent

Informed consent was obtained from all individual participants included in the study. No patient identifying information is used in this article.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Lin BC, Fang JF, Wong YC, Liu NJ. Blunt pancreatic trauma and pseudocyst: management of major pancreatic duct injury. Injury. 2007;38:588–93.CrossRefGoogle Scholar
  2. 2.
    Asensio JA, Demetriades D, Berne JD, Falabella A, Gomez H, Murray J, et al. A unified approach to the surgical exposure of pancreatic and duodenal injuries. Am J Surg. 1997;174:54–60.CrossRefGoogle Scholar
  3. 3.
    Blocksom JM, Tyburski JG, Sohn RL, Williams M, Harvey E, Steffes CP, et al. Prognostic determinants in duodenal injuries. Am Surg. 2004;70:248–55.PubMedGoogle Scholar
  4. 4.
    Huerta S, Bui T, Porral D, Lush S, Cinat M. Predictors of morbidity and mortality in patients with traumatic duodenal injuries. Am Surg. 2005;71:763–7.PubMedGoogle Scholar
  5. 5.
    Biffl WL. Duodenum and pancreas. In: Mattox KL, Moore EE, Feliciano DV, editors. Trauma. 7th ed. New York, NY: McGraw-Hill; 2012. p. 603Y619.Google Scholar
  6. 6.
    García Santos E, Soto Sánchez A, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: review of the literature. Cir Esp. 2015;93:68–74.CrossRefGoogle Scholar
  7. 7.
    Shah S, Khosa F, Rai S, McLaughlin P, Louis L, Nicolaou S. Imaging blunt pancreatic and duodenal trauma. Appl Radiol. 2016;45:22–8.Google Scholar
  8. 8.
    Chrysos E, Athanasakis E, Xynos E. Pancreatic trauma in the adult: current knowledge in diagnosis and management. Pancreatology. 2002;2:365–78.CrossRefGoogle Scholar
  9. 9.
    Kataria H, Kaushik R, Singh S, Sharma R. Pancreas sparing duodenectomy for duodenal trauma. Hell J Surg. 2017;89:121–8.CrossRefGoogle Scholar
  10. 10.
    Cogbill TH, Moore EE, Feliciano DV, Hoyt DB, Jurkovich GJ, Morris JA, et al. Conservative management of duodenal trauma: a multicenter perspective. J Trauma. 1990;30:1469–75.CrossRefGoogle Scholar
  11. 11.
    Charles BF, Dana KA, Timothy RB, David LD, John GH, Raphael EP. Schwartz’s principles of surgery, vol. 26. 8th ed. Newyork: McGraw Hill Company; 2004. p. 1007–9.Google Scholar
  12. 12.
    Berne CJ, Donovan AJ, White EJ, Yellin AE. Duodenal “diverticulization” for duodenal and pancreatic injury. Am J Surg. 1974;127:503–7.CrossRefGoogle Scholar
  13. 13.
    Vaughan GD, Frazier OH, Graham DY, Mattox KL, Petmecky FF, Jordan GL. The use of pyloric exclusion in the management of severe duodenal injuries. Am J Surg. 1977;134:785–90.CrossRefGoogle Scholar
  14. 14.
    Asensio JA, Feliciano DV, Britt LD, Kerstein MD. Management of duodenal injuries. Curr Probl Surg. 1993;30:1026–92.CrossRefGoogle Scholar
  15. 15.
    Duchesne JC, Schmieg R, Islam S, Olivier J, McSwain N. Selective nonoperative management of low-grade blunt pancreatic injury: are we there yet? J Trauma. 2008;65:49–53.CrossRefGoogle Scholar
  16. 16.
    Fisher M, Brasel K. Evolving management of pancreatic injury. Curr Opin Crit Care. 2011;17:613–7.CrossRefGoogle Scholar
  17. 17.
    Degiannis E, Boffard K. Duodenal injuries. Br J Surg. 2000;87:1473–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018 2018

Authors and Affiliations

  1. 1.Northern General HospitalSheffieldUK
  2. 2.Red Cross HospitalAthensGreece

Personalised recommendations