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Zakarya AH, Mouna L, Loubna A, Houda O, Mounir E, Fouad E, Hicham Z. Duodenal Trauma in Children: What is the Status of Non-Operative Conservative Treatment? Glob Pediatr Health 2023; 10:2333794X231156057. [PMID: 36992845 PMCID: PMC10041607 DOI: 10.1177/2333794x231156057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 03/28/2023] Open
Abstract
Conservative treatment of duodenal trauma in children has long been the first line of treatment for duodenal wall hematomas. However, it has rarely been described in duodenal perforations. Our purpose is to highlight the possibility of conservative treatment in selected cases of duodenal perforation. In the period between 2009 and 2022, 6 children were treated for duodenal injury following abdominal blunt trauma in the pediatric surgical emergency department. The clinical presentation, diagnosis and treatment are reported and analyzed. Three patients presented with duodenal hematomas, they were treated non-operatively with hospital stays between 12 and 20 days and good clinical outcome. One child presented with duodenal hematoma and retroperitoneal air bubbles; non-operative conservative treatment was carried with favorable results. The fifth patient had a duodenal perforation; he underwent a primary duodenal 2-layers closure. The last patient had a combination of duodenal hematoma and perforation involving 75% of the duodenal diameter for which he underwent a gastro-jejunostomy with pyloric exclusion. An isolated duodenal lesion can be subject to a conservative treatment whenever allowed by a stable clinical condition and the availability of appropriate clinical and radiological monitoring.
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Affiliation(s)
- Alami Hassani Zakarya
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
- Zakarya Alami Hassani, Surgical Pediatric Emergency Department, Children’s Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Rue Mohamedia, Immeuble No. 14, Appartment No. 3, Hassan, Rabat 10100, Morocco.
| | - Lazrak Mouna
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Aqqaoui Loubna
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Oubejja Houda
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Erraji Mounir
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Ettayebi Fouad
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
| | - Zerhouni Hicham
- Faculty of medicine and pharmacy of Rabat, Mohamed V University, Rabat, Morocco
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Alshehri A, Alsinan TA. Perforated duodenal ulcer secondary to deferasirox use in a child successfully managed with laparoscopic drainage: A case report. World J Clin Cases 2022; 10:12775-12780. [PMID: 36579108 PMCID: PMC9791504 DOI: 10.12998/wjcc.v10.i34.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A perforated gastroduodenal ulcer is rarely observed in children. Certain medications have been reported to cause ulcerations. Deferasirox, an iron chelating agent, has been previously reported to be associated with the development of gastroduodenal ulcers.
CASE SUMMARY We report a case of a 3-year-old boy who was diagnosed with beta thalassemia major and treated with deferasirox. He presented to the emergency department with an acute abdomen. A perforated duodenal ulcer was suspected after X-ray imaging and laparoscopic exploration. It was successfully managed with laparoscopic washout and drainage.
CONCLUSION Due to the rarity and severity of this case, it is a reminder that prevention and early recognition of gastrointestinal complications in patients receiving deferasirox are crucial. Minimally invasive laparoscopic surgery is both safe and feasible to treat perforated duodenal ulcers in selected patients.
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Affiliation(s)
- Abdullah Alshehri
- Department of Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Tuqa Adil Alsinan
- Department of Pediatric Surgery, Prince Sultan Military Medical City, Riyadh 12211, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 12211, Saudi Arabia
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Shah H, Sabbah BN, Elwy BA, Arabi TZ, Sabbah AN, Shah SY. Duodenal transection following a seat belt injury: A case report. Int J Surg Case Rep 2022; 96:107272. [PMID: 35704986 PMCID: PMC9198315 DOI: 10.1016/j.ijscr.2022.107272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The rare presentation of duodenal injuries has led to a lack of guidelines for managing and diagnosing such cases. In most duodenal injuries, intramural hematoma and perforation are seen; however, complete resection of the duodenum is rare, which is seen in our case. CASE PRESENTATION We report a rare case of a 6-year-old boy who suffered from a complete isolated duodenal transection at the pylorus and a 90% transection at D3 and D4 following a seat-belt injury. The surgeon performed a primary anastomosis for the first part of the duodenum with pyloric exclusion. Then, primary repair with controlled fistula for the second transection at D3 and D4 and a gastrojejunostomy were performed. After further management, the patient was discharged with no further complaints. CLINICAL DISCUSSION Due to the retroperitoneal location of the duodenum, it is challenging to diagnose a duodenal injury. CT scan with contrast is considered the best diagnostic tool in the case of a duodenal injury. Treatment of duodenal injuries depends on the type of injury and the present level of damage. It is imperative to differentiate between a duodenal hematoma, a duodenal perforation, or a duodenal transection as the management for each complication differs. CONCLUSION No official guidelines have been set in the case of management or diagnosis of duodenal transection. Based on our experience with this patient and similar literature, guidelines for managing and diagnosing duodenal transection should be set, and further studies on the matter are warranted.
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Affiliation(s)
- Hassan Shah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Belal Nedal Sabbah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Corresponding author at: 7357 Al-Hayaniyah Street, Riyadh 19705, Saudi Arabia.
| | - Badr Ahmed Elwy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Syed Yousaf Shah
- Department of Pediatric Surgery, King Salman Hospital, Riyadh, Saudi Arabia
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Wani SA, Rashid KA. Isolated duodenal perforation in children: Importance of high index of suspicion following blunt trauma abdomen. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221103055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Isolated duodenal perforation (IDP) is rare and only isolated cases are reported in the literature. Due to its rarity and subtle presentation, the diagnosis of IDP is often delayed. Delay in the diagnosis and surgical intervention result in increased morbidity and mortality. The aim of this article is to highlight the importance of a high index of suspicion of IDP following blunt abdominal trauma and safety of primary repair without diversion in such cases. Material and methods Children with isolated duodenal injuries following blunt abdominal trauma were included; mode of trauma, clinical presentation, diagnosis, operative intervention and outcome were studied. Results Nine patients with isolated duodenal perforations were identified and operated on. Most had minimal clinical findings on arrival and were haemodynamically stable. Abdominal radiography and ultrasonography were unremarkable. However, pain remained persistent and worsening of vomiting was seen over time. Contrast-enhanced computed tomography (CECT) of the abdomen with oral and intravenous contrast was done to identify the injuries. Primary repair of perforation was performed in all cases. The most common cause was road traffic accident. There were three Grade 2 injuries, five Grade 3 and one Grade 4 injuries. Eight patients healed well with uneventful recovery – one patient died from sepsis after presenting 24 h after injury with frank peritonitis. Conclusion Isolated duodenal perforation presents without specific signs and symptoms and a high index of suspicion is necessary for early diagnosis. Contrast-enhanced computed tomography of the abdomen with oral contrast should be ordered early if symptoms persist or worsened over time.
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Affiliation(s)
- Sajad A Wani
- Department of Pediatric Surgery, Govt Medical College Srinagar Kashmir, Srinagar, India
| | - Kumar A Rashid
- Department of Pediatric Surgery, Govt Medical College Srinagar Kashmir, Srinagar, India
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Hoshi R, Uehara S, Furuya T, Kaneda H, Koshinaga T. Conservative treatment for duodenal perforation after blunt trauma in a child. Pediatr Int 2022; 64:e14965. [PMID: 35189000 DOI: 10.1111/ped.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Reina Hoshi
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi, Japan
| | - Takeshi Furuya
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi, Japan
| | - Hide Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi, Japan
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Goh B, Soundappan SSV. Traumatic duodenal injuries in children: a single-centre study. ANZ J Surg 2020; 91:95-99. [PMID: 33369841 DOI: 10.1111/ans.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/07/2020] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic duodenal injuries in children are rare, and few studies have documented duodenal injuries in children, especially in Australasia. This study assessed the mechanism, investigations, management and outcomes of children (aged <16 years) with duodenal injuries. METHODS Retrospective review was conducted over a 16-year period from a single paediatric trauma centre. RESULTS Sixteen cases of duodenal injuries were identified: 15 cases of blunt duodenal injury and only one case of penetrating injury. Motor vehicular accidents were the most common cause of injury, followed by auto-pedestrian injuries and handlebar injuries. Only grade I and II injuries were identified. Computed tomography aided diagnosis in all cases of blunt duodenal injuries, especially given the variable nature of symptoms. Eight patients underwent laparotomy, of whom five required duodenal repair. Three patients underwent primary repair with omental patch, one patient underwent primary repair with gastrostomy and one patient underwent two-layered repair with t-tube duodenostomy. There were no delays in operative management within 24 h and no complications identified. CONCLUSION In comparison to other paediatric trauma centres worldwide, the majority of duodenal injuries were low grade and attributed to blunt trauma. Computed tomography aided diagnosis in all cases of blunt duodenal injury. Primary repair of duodenal injuries was possible in the majority of cases requiring operative repair.
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Affiliation(s)
- Barnabas Goh
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Cross-Sectional Imaging Evaluation of Vascular Lesions in the Gastrointestinal Tract and Mesentery. J Comput Assist Tomogr 2020; 44:870-881. [PMID: 33196596 DOI: 10.1097/rct.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal (GI) tract and mesenteric vascular lesions can have various clinical presentations, of which GI bleeding is the most common. This collection of pathology is highly variable in etiology ranging from occlusive disease to vascular malformations to trauma to neoplasms which makes for a challenging workup and diagnosis. The advent of multiple imaging modalities and endoscopic techniques makes the diagnosis of these lesions more achievable, and familiarity with their various imaging findings can have a significant impact on patient management. In this article, we review the gamut of GI tract and mesenteric vascular lesions and their associated imaging findings.
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Briganti V, Tursini S, Ianniello S, Cortese A, Faggiani R. Double isolated asynchronous duodenal perforation due to abdominal blunt trauma in a child: A case report. Int J Surg Case Rep 2020; 77:67-70. [PMID: 33157336 PMCID: PMC7644788 DOI: 10.1016/j.ijscr.2020.09.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
This is the first case described in literature of a double asynchronous isolated perforation of the duodenum. Timing of diagnosis and treatment are described. Radiologic findings are provided.
Background Isolated duodenal perforation following blunt abdominal trauma is a rare injury in children. Bicycle accidents (falling on to the handlebar) are a frequent cause of blunt abdominal trauma in children and may occasionally be associated with isolated duodenal perforation (IDP). Prompt diagnosis and surgical treatment are vital to prevent increased morbidity and mortality. Case presentation We report the rare case of an 11-year-old boy admitted for blunt abdominal trauma and treated for an asynchronous double IDP. The first perforation, located on the 2nd/3rd portion of the duodenum, was promptly diagnosed by contrast-enhanced abdominal CT scan after a negative US scan, five hours after injury, and the lesion repaired with a single stitch suture. The second duodenal perforation appeared in the duodenal bulb as a worsening biliary leakage, 48 h after the primary suture of the initial lesion. The perforation was initially seen by digestive endoscopy and sutured in the same way as the first lesion. A third laparotomy was needed 4 days later due to an intestinal obstruction, after which the patient was recovered completely and was discharged home. Discussion and conclusion IDP is a rare consequence of blunt abdominal trauma, and is normally associated with a lesion of other organs, such as the pancreas or bile duct. A delayed diagnosis strongly increases the incidence of morbidity and mortality, and different kinds of surgical management have been proposed, depending on the type of lesion. To our knowledge, this is the first case described in literature of a double isolated asynchronous duodenal perforation following blunt abdominal trauma in children.
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Affiliation(s)
- V Briganti
- Pediatric Surgery Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - S Tursini
- Pediatric Surgery Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy.
| | - S Ianniello
- Emergency Radiology Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - A Cortese
- Radiology Operative Unit Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - R Faggiani
- Gastroenterology and Diagnostic and Operative Digestive Endoscopy Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
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Kato H, Mitani Y, Goda T, Watanabe T, Kubota A, Yamaue H. A case of pediatric duodenal transection caused by abuse successfully treated by duodenojejunostomy. Acute Med Surg 2020; 7:e541. [PMID: 32685176 PMCID: PMC7358249 DOI: 10.1002/ams2.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022] Open
Abstract
Background Abuse can be a cause of pediatric duodenal injury. Patients who have been injured by abuse tend to have delay before medical examination, they may therefore have especially poor prognosis. Case presentation A 3‐year‐old boy presented with abdominal pain and was diagnosed with duodenal perforation. He was urgently transferred to our hospital for surgery. There was no clear history of trauma according to initial parent interviews, but old bruises were observed in several places. Paternal remarks about the injury mechanism were contradictory to bruit findings. Eventually, the mother reported daily paternal domestic violence against the patient. Duodenal perforation was considered to be caused by physical abuse, and emergent surgery was carried out. Intraoperative findings revealed transection at the horizontal part of the duodenum. Primary repair was difficult due to severe damage, so duodenojejunostomy was undertaken. Conclusion Duodenojejunostomy was successfully carried out as emergent surgery for severely damaged duodenal transection.
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Affiliation(s)
- Hirotaka Kato
- Second Department of Surgery Wakayama Medical University Wakayama Japan
| | - Yasuyuki Mitani
- Second Department of Surgery Wakayama Medical University Wakayama Japan
| | - Taro Goda
- Second Department of Surgery Wakayama Medical University Wakayama Japan
| | - Takashi Watanabe
- Second Department of Surgery Wakayama Medical University Wakayama Japan
| | - Akio Kubota
- Second Department of Surgery Wakayama Medical University Wakayama Japan
| | - Hiroki Yamaue
- Second Department of Surgery Wakayama Medical University Wakayama Japan
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10
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Biyyam DR, Hwang S, Patel MC, Bardo DME, Bailey SS, Youssfi M. CT Findings of Pediatric Handlebar Injuries. Radiographics 2020; 40:815-826. [PMID: 32364888 DOI: 10.1148/rg.2020190126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Direct bicycle handlebar injuries are a significant cause of chest and abdominal trauma and morbidity in the pediatric population. However, these injuries have been underemphasized. While blunt abdominal trauma has been described well, the literature is limited in reviewing trauma imaging specifically related to direct handlebar injuries in the pediatric population. Major chest injuries include lung contusions, pneumatoceles, and pneumothorax. In the abdomen, injuries to the pancreas, small bowel, mesentery, liver, and spleen are the more common abdominal injuries attributed to direct handlebar trauma. Traumatic abdominal wall hernias and groin injuries, which may be associated with vascular injuries, are other known injuries. The challenge is in both clinical and radiographic diagnosis. The physical findings are often underwhelming, and laboratory values in many studies are shown to be not very sensitive or specific. As a result, there is a risk of delay in imaging, diagnosis, and treatment of significant and sometimes life-threatening injuries. CT is considered the standard examination to delineate intra-abdominal trauma, with a reported sensitivity of 60%-88% and a specificity of 97%-99%. Moreover, CT helps in grading some types of injury and helps guide the surgical treatment course. It is important for radiologists who perform imaging in adults and children to be aware of the significance of direct handlebar injuries and their imaging findings. ©RSNA, 2020.
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Affiliation(s)
- Deepa Reddy Biyyam
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Steven Hwang
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Mittun C Patel
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Dianna M E Bardo
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Smita S Bailey
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
| | - Mostafa Youssfi
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016
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Kim SJ, Lee JH, Park SM, Kwon KH. Conservative management of traumatic acute intramural hematoma of duodenal 2nd and 3rd portion: A case report and review of literature. Ann Hepatobiliary Pancreat Surg 2020; 24:109-113. [PMID: 32181439 PMCID: PMC7061041 DOI: 10.14701/ahbps.2020.24.1.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022] Open
Abstract
Traumatic intramural duodenal hematoma (IMDH) is a rare disease occurring usually in children. The treatment modality of traumatic IMDH varies according to clinical manifestations. We had a case of a young man who had traumatic IMDH and treated nonoperatively. He had 3 weeks of conservative care and has been discharged, with follow up abdominal CT scan showing complete resolution of the hematoma. In conclusion, patient with traumatic acute intramural hematoma of duodenal 2nd and 3rd portion have excellent clinical outcomes with conservative therapy.
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Affiliation(s)
- Sun Jeong Kim
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jin Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Su Mi Park
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kuk Hwan Kwon
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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12
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Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:56. [PMID: 31867050 PMCID: PMC6907251 DOI: 10.1186/s13017-019-0278-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.
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Shimizu T, Umemura T, Fujiwara N, Nakama T. Review of pediatric abdominal trauma: operative and non-operative treatment in combined adult and pediatric trauma center. Acute Med Surg 2019; 6:358-364. [PMID: 31592319 PMCID: PMC6773634 DOI: 10.1002/ams2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022] Open
Abstract
Aim More than 90% of pediatric solid organ abdominal injuries are treated non‐operatively. It remains difficult to decide who should graduate to surgical management, more so if adult physicians must make these decisions on pediatric patients. The purpose of this study was to examine outcomes of all pediatric abdominal trauma cases in a single center, focusing on the decision‐making algorithm for operative or non‐operative treatment by pediatric and adult physicians. Methods We undertook a retrospective review of a pediatric trauma database from April 2006 to March 2016. Groups were divided into operative and non‐operative, single or multi‐organ injury, and adult or pediatric physician. Operative treatments included laparotomy or interventional radiology procedures. Primary outcome was survival within 30 days. Results There were 53 abdominal trauma cases; among them, 48 (90.6%) survived and 5 (9.4%) died within 30 days. The probability of survival for mortalities was less than 11%. Forty‐two cases were treated non‐operatively and 11 operatively. Injury Severity Score was higher in operative group (17 [9, 41]/9 [4, 16.3]). Adult physicians saw 33 patients including seven operative, whereas pediatric physicians saw 20 including four operative cases. There was no statistical difference for the management decision between adult and pediatric physicians. Conclusion Our decisions for intervention were within acceptable rates. Adult physicians did not tend to operate more, but there were cases that did not fit the criteria of the algorithm. Further investigation is needed to look at which factors should be focused on to determine whether or not operative treatments are indicated.
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Affiliation(s)
- Toru Shimizu
- Department of Pediatric Surgery Okinawa Prefectural Nanbu Children's Medical Center Haebaru-cho Japan
| | - Takehiro Umemura
- Department of Emergency Medicine Okinawa Prefectural Nanbu Children's Medical Center Haebaru-cho Japan
| | - Naoki Fujiwara
- Department of Pediatric Intensive Care Okinawa Prefectural Nanbu Children's Medical Center Haebaru-cho Japan
| | - Tsukasa Nakama
- Department of Pediatric Surgery Okinawa Prefectural Nanbu Children's Medical Center Haebaru-cho Japan
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GÜNEŞ ALİERDAL, Gözeneli O, Akal A, Taşkın A, Sezen H, Güldür ME. Is Hyperbaric Oxygen Therapy and Thymoquinone Effective in the Treatment of Blunt Duodenal Injury? An Experimental Study. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.395839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Garside G, Khan O, Mukhtar Z, Sinha C. Paediatric duodenal injury complicated by common bile duct rupture due to blunt trauma: a multispecialist approach. BMJ Case Rep 2018; 2018:bcr-2018-225221. [PMID: 30158263 DOI: 10.1136/bcr-2018-225221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of late presenting duodenal perforation with common bile duct rupture secondary to blunt handlebar trauma in an 11-year-old boy. The patient presented with upper abdominal wall ecchymosis, pain and vomiting. He was discharged after 24 hours with resolving symptoms. However, the boy presented 2 days later febrile with signs of peritonitis. CT indicated duodenal perforation, which was confirmed during laparotomy where common bile duct rupture was also demonstrated. Primary repair of the duodenum was undertaken. Here, decompression was achieved with a nasogastric tube proximal to the injury and T-tube duodenostomy distally. Common bile duct repair was achieved over a biliary stent. This case represents a rare subset of duodenal injury for which there is a paucity of evidence for optimal surgical management, particularly in the paediatric setting. This operative plan will guide surgeons and junior doctors in managing complicated cases like this in future.
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Affiliation(s)
| | - Omar Khan
- Department of Upper GI and Bariatric Surgery, St George's Hospital, London, UK
| | - Zahid Mukhtar
- Department of Paediatric Surgery, St George's Hospital, London, UK
| | - Chandrasen Sinha
- Department of Paediatric Surgery, St George's Hospital, London, UK
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Abstract
PURPOSE To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center. METHODS We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.1.0. RESULTS 170 children presented with pancreatic and/or duodenal injury. 13 (7.7%) suffered a combined injury and this group forms the basis for this report with mean ISS of 22.8 (± 15.1), RTS2 of 6.4(± 2.1), and median age of 6.6 (1.3-13.5) years. Child abuse (31%) and bicycle injuries (23%) were the most common mechanisms. 8/13 (61.5%) required operative intervention. Higher AAST pancreatic and duodenal injury grade (2.9 vs. 1.2, p = 0.05 and 3.6 vs. 1.4, p = < 0.01), lower RTS2 (7.84 vs. 5.49, p < 0.01), and lower GCS (9.6 vs. 15, p = 0.03) predicted operative intervention. 6/8 (75%) undergoing surgery survived to discharge with only (2/6) survivors suffering postoperative complications. Both mortalities were secondary to severe traumatic brain injury. CONCLUSION Surgical management of complex pancreaticoduodenal injury is an uncommon traumatic event that is associated with high injury severity, but survival occurs in most scenarios.
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Telfah MM. Isolated duodenal rupture: primary repair without diversion; is it safe? Review of literature. BMJ Case Rep 2017; 2017:bcr-2016-215251. [PMID: 28433976 DOI: 10.1136/bcr-2016-215251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the associated morbidity and mortality. The debate is about the optimum operative management. We report a 6-year-old child who presented with acute abdominal pain due to isolated duodenal injury following blunt abdominal trauma. Emergency laparotomy revealed duodenal rupture at the junction of the first and second part of duodenum and absence of any other visceral injuries. The duodenal injury was defined as grade III, that is, involving 75% of the circumference. We opted to perform primary repair of the injured duodenum in two layers alone without diversion. The abdominal cavity was drained using an open system drain next to the repair. Nasogastric and jejunostomy tubes were used postoperatively for gastric decompression and enteral feeding, respectively. The child had an uneventful recovery, was discharged well on the 10th postoperative day and no stenosis was found on long-term follow-up. The debate was whether to repair the defect primarily or to combine the repair with diversion. Early diagnosis, the isolated nature of the duodenal injury and the possibility of minimal contamination favoured primary repair of the defect without diversion. The good outcome attributed to these factors were in agreement with most of the literature.
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Affiliation(s)
- Muwaffaq Mezeil Telfah
- Department of Surgery, Al Jumhoori Teaching Hospital, College of Medicine, University of Mosul, Mosul City, Iraq
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Homma Y, Mori K, Ohnishi Y, Fujioka K, Terada T, Sasaki A, Nagai T, Inoue M. Ultrasound follow-up in a patient with intestinal obstruction due to post-traumatic intramural duodenal hematoma. J Med Ultrason (2001) 2016; 43:431-4. [PMID: 27194436 DOI: 10.1007/s10396-016-0717-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Abstract
We report the case of a 7-year-old girl with intestinal obstruction due to post-traumatic intramural duodenal hematoma. She had fallen from the monkey bars the day before presenting to our hospital, and was admitted with signs of abdominal pain, vomiting, and nausea. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a heterogeneous solid mass located within the duodenal wall, compressing the descending part of the duodenum. The inferior vena cava was also compressed by the mass lesion, although no associated symptoms were evident. Based on these findings, the mass lesion was considered to represent intramural hematoma causing intestinal obstruction. She was managed conservatively with total parenteral nutrition. Although CT and MRI are useful for differentiating hematoma from other intestinal tumors, ultrasonography is minimally invasive and easier to perform repeatedly. In case of duodenal hematoma, ultrasonography may be quite helpful for diagnosis and follow-up by monitoring tumor size and characteristics, and the degree of duodenal compression during conservative treatment.
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Affiliation(s)
- Yukako Homma
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan.
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Yasuhiro Ohnishi
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Keisuke Fujioka
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Tomomasa Terada
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Ayumi Sasaki
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Takashi Nagai
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
| | - Miki Inoue
- Department of Pediatrics, Tokushima Prefectural Central Hospital, 1-10-13 Kuramoto-cho, Tokushima, Tokushima, 770-8539, Japan
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Hartman S, Petroze R, McGahren E. Two Cases of Abdominal Pain after Trauma. Pediatr Rev 2016; 37:e16-8. [PMID: 27037109 DOI: 10.1542/pir.2015-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stephanie Hartman
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Robin Petroze
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Eugene McGahren
- Department of Surgery, University of Virginia, Charlottesville, VA
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20
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Bradley M, Bonds B, Dreizin D, Colton K, Shanmuganathan K, Scalea TM, Stein DM. Indirect signs of blunt duodenal injury on computed tomography: Is non-operative management safe? Injury 2016; 47:53-8. [PMID: 26510408 DOI: 10.1016/j.injury.2015.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Clear signs of duodenal injury (DI) such as pneumoperitoneum and/or oral contrast extravasation mandate laparotomy. Management when computed tomography (CT) reveals indirect evidence of DI namely duodenal hematoma or periduodenal fluid is unclear. We evaluated the utility of indirect signs to identify DI and the success of expected management, hypothesizing patients with indirect evidence of DI on CT can be safely managed non-operatively. METHODS We retrospectively reviewed patients with a computed tomography (CT) scan with periduodenal hematoma or periduodenal fluid treated between January 2003 and January 2013 at a level 1 Trauma Center. Demographics, injury characteristics, laboratory values, injury severity scores (ISS), and outcome measures were recorded. Patients having immediate laparotomy were compared to those initially managed nonoperatively. RESULTS We identified 74 patients with indirect signs of DI, with 35 patients (47%) undergoing immediate operative exploration and 39 (53%) initially managed non-operatively. Lactate (4.5 mg/dL, standard deviation (SD) 2.1 vs 3.1 mg/dL, SD 1.4, p<0.001), ISS (median (IQR) 34 (27-44) vs. 24 (17-34), p=0.002) and abdominal AIS (3 (3-4) vs 2 (2-3), p<0.001) were higher in those with immediate operation. The incidence of DI requiring operative repair was 11% (8 of 74). Six of 35 (17%) explored urgently had a DI requiring repair while 29 of 35 (83%) had no DI or minor injury not requiring surgical therapy. Of those managed non-operatively, 7 of 39 (18%) failed observation but only two (5%) required duodenal repair. There was no significant difference in intensive care unit (ICU) (10.2 days, standard error [SE] 2.1 vs 9.7 days, SE 4.8, p=0.93) or hospital (22.5 days, SE 3.8 vs 23.6 days, SE 8.5, p=0.91) length of stay between those operated on immediately and those that failed non-operative management when adjusted for age, sex, and ISS. There was no mortality in the non-operative group related to an intra-abdominal injury. CONCLUSION Observation of patients with indirect sign of DI fails in about 20% of patients, but failure rate due to DI is low at 5%. Conservative management in appropriately selected patients is reasonable with close observation.
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Hartholt KA, Dekker JWT. Duodenal perforation as result of blunt abdominal trauma in childhood. BMJ Case Rep 2015; 2015:bcr-2015-213330. [PMID: 26698210 DOI: 10.1136/bcr-2015-213330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.
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Affiliation(s)
| | - Jan Willem T Dekker
- Department of Surgery-Traumatology, Reinier de Graaf Group, Delft, The Netherlands
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22
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Zundel S, Szavay P. Konservative vs. chirurgische Therapie des Bauchtraumas. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Peterson ML, Abbas PI, Fallon SC, Naik-Mathuria BJ, Rodriguez JR. Management of traumatic duodenal hematomas in children. J Surg Res 2015; 199:126-9. [DOI: 10.1016/j.jss.2015.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 12/01/2022]
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24
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Chandrasekaran A. Pancreatico duodenectomy for pediatric combined duodenal, pancreatic and biliary trauma. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408615580203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreaticoduodenal trauma in children is uncommon but carries high morbidity and mortality rates, especially when the diagnosis is delayed. A case of combined pancreatico duodenal and bile duct injury following blunt abdominal trauma is described which presented two days after injury. It highlights the extremes of surgical procedures that may be needed in massive blunt trauma.
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Abstract
Trauma is the leading cause of death in children of all ages. The most common site of injury in pediatric patients is the head followed by the extremities and the abdomen. Though less than 10% of admissions to the hospital are secondary to intra-abdominal injuries, mortality related to these injuries is not insignificant. Pancreatic and duodenal trauma occurs in 3 to 12% of the patients with abdominal injuries and can be associated with significant morbidity. The management of pancreatic and duodenal trauma in children is based mostly on adult data, but there is an increasing volume of research on the subject.
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Affiliation(s)
- Aaron Lesher
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Regan Williams
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
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26
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Sheybani EF, Gonzalez-Araiza G, Kousari YM, Hulett RL, Menias CO. Pediatric nonaccidental abdominal trauma: what the radiologist should know. Radiographics 2015; 34:139-53. [PMID: 24428287 DOI: 10.1148/rg.341135013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal injury in nonaccidental trauma (NAT) is an increasingly recognized cause of hospitalization in abused children. Abdominal injuries in NAT are often severe and have high rates of surgical intervention. Certain imaging findings in the pediatric abdomen, notably bowel perforation and pancreatic injury, should alert the radiologist to possible abuse and incite close interrogation concerning the reported mechanism of injury. Close inspection of the imaging study is warranted to detect additional injury sites because these injuries rarely occur in isolation. When abdominal injury is suspected in known or speculated NAT, computed tomography (CT) of the abdomen and pelvis with intravenous contrast material is recommended for diagnostic and forensic evaluation. Although the rate of bowel injury is disproportionately high in NAT, solid organs, including the liver, pancreas, and spleen, are most often injured. Adrenal and renal trauma is less frequent in NAT and is generally seen with multiple other injuries. Hypoperfusion complex is a constellation of abdominal CT findings that indicates current or impending decompensated shock and is most often due to severe neurologic impairment in NAT. Although abdominal injuries in NAT are relatively uncommon, knowledge of injury patterns and their imaging appearances is important for patient care and protection.
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Affiliation(s)
- Elizabeth F Sheybani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo
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27
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Duodenal hematoma following EGD: comparison with blunt abdominal trauma-induced duodenal hematoma. J Pediatr Gastroenterol Nutr 2015; 60:69-74. [PMID: 25207477 DOI: 10.1097/mpg.0000000000000564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Duodenal hematoma (DH) is a rare complication of esophagogastroduodenoscopy (EGD) with duodenal biopsy and uncommon, but better described following blunt abdominal trauma (BAT). We aimed to describe DH incidence and investigate risk factors for DH development post-EGD and compare its features to those post-BAT. METHODS Multiple electronic databases were searched for the diagnosis of DH from 2000 to 2012. Inclusion criteria were patients 0 to 21 years of age who developed a DH following EGD with biopsy or BAT. Exclusion criteria were DH secondary to any other mechanism, EGD performed at another medical center, and insufficient information in the electronic medical record to determine treatments or outcomes. RESULTS A total of 14 post-EGD and 15 post-BAT patients with DH were included in the study. There were 26,905 EGDs with duodenal biopsies performed during the study period, for an incidence of 1:1922 procedures. Thirteen of 14 (93%) post-EGD DH events occurred between 2007 and 2012 (P < 0.001). The proportion of procedures performed under general anesthesia versus moderate sedation, and performed in the supine position versus left lateral decubitus were close to but did not reach statistical significance. DH-related complications and time to hematoma resolution was similar between groups. CONCLUSIONS In a 13-year study period, 14 patients developed DH after EGD, for an incidence of 1:1922. Method of sedation and supine positioning of the patient during endoscopy warrant further investigation as potential risks. The clinical course and time to recovery with conservative management are similar between patients with EGD and BAT-induced DH.
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28
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An isolated duodenal perforation in pediatric blunt abdominal trauma: a rare but distinct possibility. BURNS & TRAUMA 2015; 3:4. [PMID: 27574650 PMCID: PMC4964077 DOI: 10.1186/s41038-015-0008-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 12/26/2022]
Abstract
Isolated duodenal perforation (IDP) in pediatric trauma is rarely reported. Since most of the children with blunt trauma are managed expectantly, timely diagnosis is imperative to avoid morbidity and mortality. We report a case of IDP and emphasize on certain specific clinical features indicating possibility of duodenal injury. We also stress upon the role of early contrast-enhanced computerized tomography (CECT) in such cases.
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Dai LN, Chen CD, Lin XK, Wang YB, Xia LG, Liu P, Chen XM, Li ZR. Abdominal injuries involving bicycle handlebars in 219 children: results of 8-year follow-up. Eur J Trauma Emerg Surg 2014; 41:551-5. [DOI: 10.1007/s00068-014-0477-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/07/2014] [Indexed: 12/26/2022]
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30
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Dumitriu D, Menten R, Smets F, Clapuyt P. Postendoscopic duodenal hematoma in children: ultrasound diagnosis and follow-up. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:550-553. [PMID: 24615821 DOI: 10.1002/jcu.22145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 09/14/2013] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
Intramural duodenal hematomas have most frequently been reported in children in a traumatic setting. We present two cases of duodenal hematoma that occurred after upper gastrointestinal tract endoscopy with biopsy in children without significant prior medical history. The diagnosis was made by ultrasound, in correlation with the clinical presentation. Because the patients were hemodynamically stable, they were treated conservatively and the regression of the hematoma was followed up with ultrasound until its complete resolution. These cases demonstrate the risks of endoscopy, which are not to be neglected even in children without impaired coagulation, and the manner in which ultrasound can provide the correct diagnosis and follow-up.
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Affiliation(s)
- Dana Dumitriu
- Cliniques Universitaires Saint Luc, Department of Radiology, Pediatric Radiology Unit, Université Catholique de Louvain, Brussels, Belgium
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Mousavi SA, Karami H. Cholestasis in a three year-old child following abdominal blunt trauma: a case report. Trauma Mon 2013; 18:139-40. [PMID: 24350173 PMCID: PMC3864400 DOI: 10.5812/traumamon.12611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/01/2013] [Accepted: 08/02/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction Extra-hepatic bile duct injuries in children following blunt abdominal trauma are rare; early diagnosis and treatment are imperative for a good outcome. The purpose of this report is to describe the management of problems encountered in children with bile duct injuries following blunt abdominal trauma. Case Presentation A three year-old girl presented with obstructive jaundice and vomiting following blunt abdominal trauma one month prior to referral. The child was sitting in her father’s lap when the accident occurred. She was then examined by an emergency physician to assess the cause of vomiting. An abdominal ultrasonography was performed and revealed dilatation of the common bile duct. Conclusions To the best of our knowledge, this is the first report of bile duct injury following blunt trauma and its emergency management.
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Affiliation(s)
- Seyed Abdollah Mousavi
- Department of Pediatric Surgery, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Seyed Abdollah Mousavi, Department of Pediatric Surgery, Booali Hospital, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel.: +98-1512233018, Fax: +98-1512235358, E-mail:
| | - Hassan Karami
- Department of Pediatric Gastroenterology, Mazandaran University of Medical Sciences, Sari, IR Iran
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32
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Maguire SA, Upadhyaya M, Evans A, Mann MK, Haroon MM, Tempest V, Lumb RC, Kemp AM. A systematic review of abusive visceral injuries in childhood--their range and recognition. CHILD ABUSE & NEGLECT 2013; 37:430-445. [PMID: 23306146 DOI: 10.1016/j.chiabu.2012.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 10/28/2012] [Accepted: 10/31/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children. METHODS We searched 12 databases, with snowballing techniques, for the period 1950-2011, with all identified studies undergoing two independent reviews by trained reviewers, drawn from pediatrics, radiology, pediatric surgery and pathology. Of 5802 studies identified, 188 were reviewed. We included studies of children aged 0-18, with confirmed abusive etiology, whose injury was defined by computed tomography, contrast studies or at surgery/post mortem. We excluded injuries due to sexual abuse, or those exclusively addressing management or outcome. RESULTS Of 88 included studies (64 addressing abdominal injuries), only five were comparative. Every organ in the body has been injured, intra-thoracic injuries were commoner in those aged less than five years. Children with abusive abdominal injuries were younger (2.5-3.7 years vs. 7.6-10.3 years) than accidentally injured children. Duodenal injuries were commonly recorded in abused children, particularly involving the third or fourth part, and were not reported in accidentally injured children less than four years old. Liver and pancreatic injuries were frequently recorded, with potential pancreatic pseudocyst formation. Abdominal bruising was absent in up to 80% of those with abdominal injuries, and co-existent injuries included fractures, burns and head injury. Post mortem studies revealed that a number of the children had sustained previous, unrecognized, abdominal injuries. The mortality from abusive abdominal injuries was significantly higher than accidental injuries (53% vs. 21%). Only three studies addressed screening for abdominal injury among abused children, and were unsuitable for meta-analysis due to lack of standardized investigations, in particular those with 'negative' screening tests were not consistently investigated. CONCLUSIONS Visceral injuries may affect any organ of the body, predominantly abdominal viscera. A non-motor vehicle related duodenal trauma in a child aged<five years warrants consideration of abuse as an etiology. In the absence of clear evidence for a screening strategy, clinical vigilance is warranted in any young child with suspected abuse for the presence of abdominal injury, where the absence of abdominal bruising or specific symptoms does not preclude significant injury.
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Affiliation(s)
- S A Maguire
- Child Health Department, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
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Smiley K, Wright T, Skinner S, Iocono JA, Draus JM. Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children. ISRN PEDIATRICS 2012; 2012:298753. [PMID: 23213560 PMCID: PMC3503329 DOI: 10.5402/2012/298753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 10/08/2012] [Indexed: 11/23/2022]
Abstract
Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages <14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I-IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries.
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Affiliation(s)
- Katherine Smiley
- University of Kentucky College of Medicine, Lexington, KY 40536, USA
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35
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Endoscopic treatment of traumatic duodenal perforation. J Pediatr Gastroenterol Nutr 2012. [PMID: 23187308 DOI: 10.1097/mpg.0b013e318245fd8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Gutierrez IM, Mooney DP. Operative blunt duodenal injury in children: a multi-institutional review. J Pediatr Surg 2012; 47:1833-6. [PMID: 23084193 DOI: 10.1016/j.jpedsurg.2012.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/09/2012] [Accepted: 04/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Operative blunt duodenal injury in children is rare. The purpose of this analysis is to describe the clinical presentation, current management, and outcome of children with operative blunt duodenal injury. METHODS The American Pediatric Surgical Association Trauma Committee solicited data from its members on children with blunt intestinal injuries identified at autopsy or operation from January 2002 through August 2006. RESULTS Fifty-four children from 16 hospitals with operative blunt duodenal injuries were identified: 0.67 patients per hospital per year. The most common mechanisms of injury were motor vehicle crashes (35%), bicycle crashes (22%), and nonaccidental trauma (20%). Forty-nine patients (90%) had positive physical examination findings on initial presentation, including peritonitis in 18 patients (33%). Twenty-five computed tomographic (CT) scans performed demonstrated free fluid, and 13 (52%), free air. Eleven CT scans used enteral contrast, and only 2 (18%) showed extravasation. Fifty-two patients (96%) survived to operation. The overall complication rate was 42%. CONCLUSION Operative blunt duodenal injury occurs less than once per year in the typical pediatric trauma center. Most of the patients have pertinent physical examination findings on arrival. Computed tomographic scans with enteral contrast do not seem to be helpful in diagnosis of duodenal injuries. Postoperative complications are frequent, but most children survive.
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Affiliation(s)
- Ivan M Gutierrez
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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37
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Huang CL, Lee JY, Chang YT. Early laparoscopic repair for blunt duodenal perforation in an adolescent. J Pediatr Surg 2012; 47:E11-4. [PMID: 22595602 DOI: 10.1016/j.jpedsurg.2011.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/02/2011] [Accepted: 12/18/2011] [Indexed: 12/12/2022]
Abstract
Duodenal perforation secondary to blunt abdominal trauma in children is rare and usually associated with delays in diagnosis and surgical intervention. The authors encountered such a case in a 12-year-old boy owing to his falling over the handlebar of a bicycle. Imaging examination showed that there was a perforation over the fourth portion of the duodenum without concomitant injuries. Using a 5-port transperitoneal laparoscopic technique, primary closure of the perforation was successfully performed at 6 hours after the impact. Laparoscopic approach appears to be safe and feasible in hemodynamically stable children with solitary traumatic duodenal perforation if the operation can be performed early in the course of the incident.
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Affiliation(s)
- Chein-Lin Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Grasshof C, Wolf A, Neuwirth F, Posovszky C. Intramural duodenal haematoma after endoscopic biopsy: case report and review of the literature. Case Rep Gastroenterol 2012; 6:5-14. [PMID: 22379465 PMCID: PMC3290028 DOI: 10.1159/000336022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The development of intramural duodenal haematoma (IDH) after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia.
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Affiliation(s)
- Claudia Grasshof
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics and Adolescent Medicine, Ulm, Germany
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39
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Nolan GJ, Bendinelli C, Gani J. Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature. World J Emerg Surg 2011; 6:42. [PMID: 22185364 PMCID: PMC3259057 DOI: 10.1186/1749-7922-6-42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/20/2011] [Indexed: 11/10/2022] Open
Abstract
Intramural Duodenal Haematoma (IDH) is an uncommon complication of blunt abdominal trauma. IDH's are most often treated non-operatively. We describe laparoscopic treatment of an IDH after failed conservative management. To our knowledge, successful laparoscopic drainage of an IDH in an adult has not been described previously in the literature.
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Affiliation(s)
- Gregory J Nolan
- Division of Surgery, University of Newcastle, John Hunter Hospital, New Lambton Heights, NSW, 2310, Australia.
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40
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Antoniou D, Zarifi M, Gentimi F, Christopoulos-Geroulanos G. Sonographic diagnosis and monitoring of an intramural duodenal hematoma following upper endoscopic biopsy in a child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:534-538. [PMID: 19757424 DOI: 10.1002/jcu.20629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Intramural duodenal hematoma is an uncommon complication of pediatric endoscopic biopsy that occurs mainly in children with bleeding disorders. We report the case of a 5-year-old girl who presented with signs of partial duodenal obstruction and acute pancreatitis due to duodenal hematoma following endoscopic biopsy. The lesion was diagnosed and monitored by sonography and resolved with conservative management.
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Affiliation(s)
- Dimitris Antoniou
- Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Thivon & Papadiamantopoulou Street, 11527 Athens, Greece
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41
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Yeung VHW, Chao NSY, Leung MWY, Kwok WK. An unusual cause of intestinal obstruction in an adolescent: a case report and management review. Pediatr Rep 2009; 1:e8. [PMID: 21589824 PMCID: PMC3096030 DOI: 10.4081/pr.2009.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 10/26/2009] [Indexed: 12/01/2022] Open
Abstract
A 15-year-old boy presented with intestinal obstruction two weeks following a blunt abdominal trauma. He had progressive bilious vomiting without abdominal distension or peritonitis. The contrast computed tomography (CT) scan of the abdomen provided the definitive diagnosis: there was an obstructing duodenal hematoma, which might have been slowly progressing or have arisen from secondary hemorrhage after the initial injury. The boy remained stable over a ten-day period of conservative treatment, and his obstructive symptoms and signs were resolved completely. A follow-up CT scan of the abdomen (16 days after admission) showed an almost complete resolution of the hematoma. Delayed duodenal hematoma causing intestinal obstruction has been reported rarely in previous literature. Occasionally a significant secondary hemorrhage resulting in intestinal obstruction can become life threatening. Clinical follow-up is paramount after initial recovery. Although conservative treatment suffices in most cases, the surgeon should be wary of the need for definitive surgical intervention if there is evidence of ongoing acute hemorrhage or of the obstructing hematoma failing to resolve. Laparoscopic drainage of the hematoma provides optimistic results for patients failing conservative management.
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Affiliation(s)
- Victor Hip-Wo Yeung
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Hong Kong
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42
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Milias K, Deligiannidis N, Papavramidis TS, Ioannidis K, Xiros N, Papavramidis S. Biliogastric diversion for the management of high-output duodenal fistula: report of two cases and literature review. J Gastrointest Surg 2009; 13:299-303. [PMID: 18825468 DOI: 10.1007/s11605-008-0677-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
High-output duodenal fistula occurs as a result of a duodenal wall defect caused by gastroduodenal surgery, endoscopic sphincterotomy, duodenal injury, and tumors with high morbidity and mortality rate. A new technique for its management is reported along with literature review. This procedure consists of transection of the duodenum 2 cm distally to the pylorus, transection of the common bile duct, and end duodenostomy with or without suturing the duodenal wall defect. The continuity of the alimentary tract is reinstated by an end-to-end duodenojejunostomy, end-to-side choledochojejunostomy, and end-to-side Roux-en-Y jejunojejunostomy, obtaining biliogastric diversion from the duodenum and closure of the fistula. This technique was performed in two patients with excellent results.
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Affiliation(s)
- Konstantinos Milias
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, Greece.
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43
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DuBose JJ, Inaba K, Teixeira PGR, Shiflett A, Putty B, Green DJ, Plurad D, Demetriades D. Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank. Am Surg 2008; 74:925-9. [PMID: 18942615 DOI: 10.1177/000313480807401009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pyloric exclusion (PEX) has traditionally been used in the management of complicated duodenal injuries to temporarily protect the duodenal repair and prevent septic abdominal complications. We used the American College of Surgeons National Trauma Data Bank (v 5.0) to evaluate adult patients with severe duodenal injuries [American Association for the Surgery of Trauma (AAST) Grade > or = 3] undergoing primary repair only or repair with PEX within 24 hours of admission. Propensity scoring was used to adjust for relevant confounding factors during outcomes comparison. Among 147 patients with severe duodenal injuries, 28 (19.0%) underwent PEX [15.9% (11/69) Grade III vs 34.0% (17/50) Grade IV-V]. Despite similar demographics, PEX was associated with a longer mean hospital stay (32.2 vs 22.2 days, P = 0.003) and was not associated with a mortality benefit. There was a trend toward increased development of septic abdominal complications (intra-abdominal abscess, wound infection, or dehiscence) with PEX that was not statistically significant. After multivariable analysis using propensity score, no statistically significant differences in mortality or occurrence of septic abdominal complications was noted between those patients undergoing primary repair only or PEX. The use of PEX in patients with severe duodenal injuries may contribute to longer hospital stay and confers no survival or outcome benefit.
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Affiliation(s)
- Joseph J DuBose
- Los Angeles County Hospital/University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA.
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44
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Successful percutaneous drainage of duodenal hematoma after blunt trauma. J Pediatr Surg 2008; 43:e13-5. [PMID: 18778981 DOI: 10.1016/j.jpedsurg.2008.03.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 03/27/2008] [Accepted: 03/28/2008] [Indexed: 11/24/2022]
Abstract
Duodenal hematoma after blunt trauma is usually treated nonoperatively with bowel rest, nasogastric tube suction, and intravenous hydration. We report a case in which obstructive symptoms persisted despite more than 2 weeks of conservative management. An ultrasound-guided percutaneous drain was placed, with successful resolution of symptoms.
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45
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Banieghbal B, Vermaak C, Beale P. Laparoscopic Drainage of a Post-Traumatic Intramural Duodenal Hematoma in a Child. J Laparoendosc Adv Surg Tech A 2008; 18:469-72. [DOI: 10.1089/lap.2007.0147] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Behrouz Banieghbal
- Division of Pediatric Surgery, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cobus Vermaak
- Division of Pediatric Surgery, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Beale
- Division of Pediatric Surgery, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Bixby SD, Callahan MJ, Taylor GA. Imaging in pediatric blunt abdominal trauma. Semin Roentgenol 2008; 43:72-82. [PMID: 18053830 DOI: 10.1053/j.ro.2007.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Children's Hospital Boston, Boston, Massachusetts 02115,
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47
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Osuka A, Idoguchi K, Muguruma T, Ishikawa K, Mizushima Y, Matsuoka T. Duodenal disruption diagnosed 5 days after blunt trauma in a 2-year-old child: report of a case. Surg Today 2007; 37:984-8. [PMID: 17952532 DOI: 10.1007/s00595-007-3529-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 02/10/2007] [Indexed: 10/22/2022]
Abstract
Blunt duodenal injury in children is uncommon and diagnosis is often delayed because of its retroperitoneal location. Both diagnosis and treatment are difficult. We report the case of a 2-year-old boy whose trauma injury was not reported for 5 days. His vital signs were stable, but he was vomiting bile-stained fluid and his stools were white. The third portion of the duodenum was completely disrupted, and was repaired by pyloric exclusion with duodenal and bile duct drainage. The child recovered uneventfully. We discuss the diagnostic strategies and therapeutic measures for this type of injury.
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Affiliation(s)
- Akinori Osuka
- Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku Orai-kita, Izumisano, Osaka 598-0048, Japan
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48
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Spaniolas K, Velmahos GC. Nonoperative Management of Pancreato-Duodenal Injuries. Eur J Trauma Emerg Surg 2007; 33:221. [PMID: 26814483 DOI: 10.1007/s00068-007-7073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 05/18/2007] [Indexed: 12/26/2022]
Abstract
Following injuries to the pancreas and duodenum (PDI) patients often present in extremis and undergo immediate laparotomy for hemodynamic instability and peritoneal signs. Nonoperative management (NOM) may be offered in selected patients with lowgrade injuries. Precise mapping of the injury, most commonly by computed tomography, is a prerequisite for NOM because clinical symptomatology can be variable and misleading. Additionally, delaying the treatment of PDI that should be corrected surgically may lead to significant complications. Therefore, NOM of PDI presents unique challenges, and the decision-making is not as straightforward as it is with NOM of other solid abdominal organs. Essentially, only duodenal hematomas without fullthickness wall perforation (Grade I and selected II) and pancreatic trauma without major duct involvement (Grade I and selected II) could be offered NOM. In these cases, the reported success rates vary from 74 to 95%. There are also a few severe pancreatic injuries that can be managed by stents with adequate reconstitution of the major pancreatic duct integrity and resolution of symptoms and without the need for operative management. Intensive monitoring and follow-up by clinical examination and repeat CT imaging is essential in these patients, as the risk of complications, and particularly a pseudocyst is high.
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Affiliation(s)
| | - George C Velmahos
- General Hospital and Harvard Medical School, Boston, MA, USA. .,, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA.
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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. [PMID: 16468514 DOI: 10.1177/000313480507100914] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study is to determine factors that predict morbidity and mortality in patients with traumatic duodenal injury (DI). A retrospective review from July 1996 to March 2003 identified 52 patients admitted to our trauma center (age 24.4 ± 2.1 years, ISS = 18.8 ± 1.76). The mortality rate for patients with duodenal injury was 15.4 per cent (n = 8). The mechanisms of injury were blunt (62%), gun shot wound (GSW) (27%), and stab wound (SW) (11%). There was no difference in mortality based on mechanism of injury. Management was primarily nonoperative [n = 30 (57%)]. Of those with perforation (n = 22), 64 per cent underwent primary repair (n = 14), 23 per cent duodenal resection (n = 5), 9 per cent duodenal exclusion (n = 2), and one patient pancreaticoduodenectomy. The method of initial surgical management was not related to patient outcome. Univariate analysis demonstrated that nonsurvivors were older, more, hypotensive in the emergency department, had a more negative initial base deficit, had a lower initial arterial pH, and had a higher Injury Severity Score. Nonsurvivors were also more likely to have an associated inferior vena cava (IVC) injury. Multivariate regression analysis revealed age, initial lowest pH, and Glasgow Coma Score to be independent predictors of mortality, suggesting that the physiologic presentation of the patient is the most important factor in predicting mortality in patients with traumatic DIs.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, UCI Medical Center, Orange, California 92868, USA
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