Abstract
Introduction
Low-velocity gunshot wounds cause most civilian duodenal injuries. The objective of this study was to describe a simplified surgical algorithm currently in use in a South African civilian trauma center and to verify its validity by measuring morbidity and mortality.
Methods
A retrospective chart review of patients with duodenal gunshot injuries during the study period January 1999 to December 2003 was performed. Data points accrued included patient demographics, admission hemodynamic status and resuscitative measures, laparotomy damage control procedures, methods of surgical repair of the duodenal injury, associated injuries, length of intensive care and hospital stays, complications, and mortality.
Results
A total of 75 consecutive patients with gunshot injuries to the duodenum were reviewed. Primary repair was performed in 54 patients (87%), resection and reanastomosis in 7 (11%), and pancreatoduodenectomy in 1 (2%) during the initial phases. The overall morbidity and mortality were 58% and 28%, respectively. Duodenum-related complications were recorded in nine (15%) patients: two duodenal fistulas, one duodenal obstruction, and six cases of suture-line dehiscence. Overall and duodenum-related morbidity rates in patients with combined pancreatoduodenal injuries were 83% and 17%, respectively. Duodenum-related mortality occurred in three (4.8%) patients.
Conclusions
Most civilian low-velocity duodenal gunshot injuries treated with simple primary repair result in overall morbidity, mortality, and duodenum-related complication rates comparable to those in reports where more complex surgical procedures were employed. Primary repair is also applicable for most combined pancreatic and duodenal gunshot injuries.
Similar content being viewed by others
References
Asensio JA, Stewart BM, Demetrides D. Duodenum. In: Ivatury RR, Cayten CG (editors). The Textbook of Penetrating Trauma. Baltimore, Williams & Wilkins, 1996, p 610
Snyder WH III, Weigelt JA, Watkins WL, et al. The surgical management of duodenal trauma: percepts based on review of 247 cases. Arch Surg 1980;115:422–429
Weigelt JA. Duodenal injuries. Surg Clin North Am 1990;70:529–539
Ivatury RR, Gaudino J, Ascher E, et al. Treatment of penetrating duodenal injuries: primary repair vs. repair with decompressive enterostomy/serosal patch. J Trauma 1985;25:337–341
Cogbill TH, Moore EE, Feliciano DV, et al. Conservative management of duodenal trauma: a multicenter perspective. J Trauma 1990;30:1469–1475
DeShazo CV, Snyder WH, Daugherty CG, et al. Mucosal pedicle graft or jejunum for large gastrointestinal defects. Am J Surg 1972;124:671–672
Papachristou DN, Fortner JG. Reconstruction of duodenal wall defects by the use of a gastric “island” flap. Arch Surg 1977;112:199–200
Walley BD, Goco I. Duodenal patch grafting. Am J Surg 1980;140:706–708
Jones SA, Gazzaniga AB, Keller TB. The serosal patch: a surgical parachute. Am J Surg 1973;126:186–196
Stone HH, Fabian TC. Management of duodenal wounds. J Trauma 1979;19:334–339
Carrillo EH, Richardson DJ, Miller FB. Evolution in the management of duodenal injuries. J Trauma 1996;40:1037–1045
Berne CJ, Donovan AJ, White EJ, et al. Duodenal “diverticulization” for duodenal and pancreatic injury. Am J Surg 1974;127:503–507
Vaughan GD 3rd, Frazier OH, Graham DY, et al. The use of pyloric exclusion in the management of severe duodenal injuries. Am J Surg 1977;134:785–790
Degiannis E, Boffard K. Duodenal injuries. Br J Surg 2000;87:1473–1479
Ivatury RR. Duodenal injuries: small but lethal lesions. Cir Gen 2003;25:59–64
Martin TD, Feliciano DV, Mattox KL, et al. Severe duodenal injuries: treatment with pyloric exclusion and gastrojejunostomy. Arch Surg 1983;118:631–635
Jurkovich GJ. The duodenum and pancreas. In: Mattox KL, Feliciano DV, Moore EE (editors). Trauma, 4th edn. New York, McGraw-Hill, 2000;735–762
Ivatury RR, Nassoura ZE, Simon RJ, et al. Complex duodenal injuries. Surg Clin North Am 1996;76:797–812
Asensio JA, Feliciano DV, Britt LD, et al. Management of duodenal injuries. Curr Probl Surg. 1993;11:1026–1100
Graham M, Mattox KL, Vaughan DG 3rd, et al. Combined pancreatoduodenal injuries. J Trauma 1979;19:340–346
Anderson CB, Weisz D, Rodger MR, et al. Combined pancreaticoduodenal trauma. Am J Surg 1973;125:530–534
Morton JR, Jordan JL Jr. Traumatic duodenal injuries. J Trauma 1968;8:127–139
Kelly G, Norton L, More G. The continuing challenge of duodenal injuries. J Trauma 1978;18:160–165
Ivatury RR, Nallathambi M, Gaudino J, et al. Penetrating duodenal injuries: analysis of 100 consecutive cases. Am Surg 1985;202:153–158
Degiannis E, Krawczylovski D, Velmahos GC, et al. Pyloric exclusion in severe penetrating injuries of the duodenum. World J Surg 1993;17:751–754
Nassoura ZE, Ivatury RR, Simon RJ, et al. A prospective reappraisal of primary repair of penetrating duodenal injuries. Am Surg 1994;60:35–39
McKenney MG, Nir I, Levi DM, et al. Evaluation of minor penetrating duodenal injuries. Am Surg 1996; 62:952–955
Ginzburg E, Carrillo EH, Sosa JL, et al. Pyloric exclusion in the management of duodenal trauma: is concomitant gastrojejunostomy necessary? Am Surg 1997;63:964–966
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Talving, P., Nicol, A.J. & Navsaria, P.H. Civilian Duodenal Gunshot Wounds: Surgical Management Made Simpler. World J. Surg. 30, 488–494 (2006). https://doi.org/10.1007/s00268-005-0245-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-0245-0