[Vacuum dressing technique to temporary cover of laparostomy]

Surgical management of complex duodenal trauma using laterolateral duodenum enteroanastomosis: A case report

Introduction and importance

Duodenal trauma is rare, however, it has high morbidity and mortality rates. Surgical treatment modalities are employed depending on severity, ranging from simple sutures to complex pancreaticoduodenectomy cases.

Case presentation

A male patient had a circular saw accident, leading to evisceration in an extensive wound from the thoracoabdominal transition to the inguinal region, with 75% laceration of the second duodenal portion circumference, laceration in hepatic segments, section from right mesocolon to transverse colon, and multiple perforations in small bowel loops between 70 and 90 cm from the angle of Treitz. Laterolateral duodenum enteroanastomosis was performed with proximal jejunum and gastroenteroanastomosis with the distal loop of the small intestine at 90 cm from the Treitz angle, and a termino lateral enteroanastomosis between food and the biliary loop at 20 cm from the gastroenteroanastomosis.

Clinical discussion

This report presents a new surgical technique for patients with penetrating duodenal trauma associated with liver and intestinal injuries, to avoid the need for more complex procedures. In addition, it demonstrates postoperative management of complications, including confection of the enteroatmospheric fistula for feeding.

Conclusion

The technique described in this article proved to be a good option for treating these lesions, as evidenced by optimal postoperative results.

•

Duodenal lesions are challenging to repair due to presentation heterogeneity.

•

The use of this new technique proved to be a safe alternative.

•

Despite the complex trauma, the patient evolved well.

Simple adaptation for dynamic Bogota bag

The use of a large Bogota bag tucked well under fascial edges to the colonic gutters and easily made elastic bands from Esmarch bandage provides a dynamic tension system that decreases subsequent trips to theatre and may allow gradual closure of the abdominal wound.

Use of alloplastic meshes in abdominal wounds of rats with induced peritonitis

Background

The use of alloplastic meshes has been historically contra-indicated in patients with infection.

Aim

To evaluate the use of polypropylene meshes in the treatment of abdominal wall defects in rats with peritonitis.

Methods

Twenty Wistar female rats were divided into two groups: induction of peritonitis (test group) and without peritonitis (control group). An abdominal wall defect was created in all animals, and polypropylene mesh was applied. The evaluation of the tensile strength of the mesh was carried out using tensiometer and microscopic analysis of the healing area was done.

Results

More adhesion of the mesh to the rat abdominal wall was observed in test group. The histopathological analyses showed prevalence of moderate to accentuated granulation tissue in both groups, without significant differences.

Conclusion

The use of the mesh coverage on abdominal wall defects of rats with induced peritonitis did not show worse results than its use in healthy animals, nor was its integration to the resident tissue any worse.