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Alsaadi D, Low D, Osman A, Mcmonagle M. Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury. Ann R Coll Surg Engl 2024; 106:413-417. [PMID: 38445581 PMCID: PMC11060854 DOI: 10.1308/rcsann.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Duodenal injuries are relatively rare but remain a management challenge with a high incidence of postoperative complications. Guidelines from the World Society of Emergency Surgery and American Association for the Surgery of Trauma favour a primary repair for less-complex injuries, but the management of more complex duodenal trauma remains controversial with varying techniques supported, including pyloric exclusion, omental or jejunal patch closure, gastrojejunostomy and pancreatoduodenectomy. We describe the techniques used in one case of complex duodenal trauma. TECHNIQUE The duodenum is approached via a standard laparotomy with Kocherisation. Primary repair of the duodenal perforations is performed using a 3/0 polydioxanone suture (PDS), followed by mobilisation of a loop of mid-jejunum against the area of duodenal trauma over the primary repair as a jejunal serosal patch. The antimesenteric jejunal serosal border is sutured to the serosa of the duodenum (serosa only) using a 3/0 PDS. Pyloric exclusion is then performed through an anterior gastrostomy, to control the volume of gastric juice entering the duodenum. The pylorus is sutured closed using an absorbable suture followed by closure of the anterior gastrostomy using a GIA stapling device.
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Affiliation(s)
- D Alsaadi
- University Hospital Waterford, Ireland
| | - D Low
- University of Pennsylvania, USA
| | - A Osman
- Saint Luke’s General Hospital, Kilkenny, Ireland
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2
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Watanabe G, Satou S, Tsuru M, Momiyama M, Nakajima K, Nagao A, Satodate H, Muramoto T, Ohata K, Noie T. Pancreas-sparing partial duodenectomy as an alternative to emergency pancreaticoduodenectomy for a major duodenal perforation: a case report. Clin J Gastroenterol 2023; 16:761-766. [PMID: 37389799 DOI: 10.1007/s12328-023-01823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250 min operative time) with 50 mL of intraoperative blood loss. She required intensive care for 3 days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.
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Affiliation(s)
- Genki Watanabe
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shouichi Satou
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan.
| | - Mao Tsuru
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | | | - Atsuki Nagao
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Takashi Muramoto
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tamaki Noie
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
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3
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Del Toro C, Cabrera-Aguirre A, Casillas J, Ivanovic A, Scortegagna E, Estanga I, Alessandrino F. Imaging spectrum of non-neoplastic and neoplastic conditions of the duodenum: a pictorial review. Abdom Radiol (NY) 2023; 48:2237-2257. [PMID: 37099183 DOI: 10.1007/s00261-023-03909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/27/2023]
Abstract
Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.
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Affiliation(s)
| | | | - Javier Casillas
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Aleksandar Ivanovic
- Department of Diagnostic Imaging, Faculty of Medicine, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Indira Estanga
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA.
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Buldanli MZ, Colapkulu N, Yener O, Ozemir IA. An Extraordinary Case of Isolated Duodenal Injury after Blunt Abdominal Trauma. J Coll Physicians Surg Pak 2022; 32:522-524. [PMID: 35330529 DOI: 10.29271/jcpsp.2022.04.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 06/14/2023]
Abstract
Duodenal injuries are rare due to their preserved retroperitoneal location. They are mostly observed after deep penetration or high-impact blunt trauma. They are difficult to diagnose and treat. Our purpose was to report a case of duodenal injury after blunt trauma with the review of the literature. A 20-year male patient was brought to Emergency Department with abdominal pain after an accident, in which he was stuck between a reversing truck and a pole. Rigidity in all abdominal quadrants was detected. Free pelvic fluid was observed in computed tomography (CT). There was a grade II laceration at the fourth part of the duodenum. The laceration was primarily sutured, and a naso-jejunal tube was placed. The patient was discharged on postoperative day-8 with uneventful recovery. In suspicion of duodenal trauma, a meticulous anamnesis, careful physical examination, proper imaging technique at appropriate timing, and surgical exploration are important to reduce morbidity and mortality. Imaging findings of retroperitoneal organ injuries can be non-specific. We suggest that surgical exploration should be the first choice of treatment in cases with acute abdomen findings. Key Words: Blunt trauma, Acute abdomen, Duodenum, Retroperitoneum.
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Affiliation(s)
- Mehmet Zeki Buldanli
- Department of General Surgery, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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5
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Wu KH, Young YR, Guo DY, Chang KC, Hsiao CT, Chang CP. A Woman with Acute Right Upper Abdominal Pain. Ann Emerg Med 2021; 78:e77-e78. [PMID: 34688447 DOI: 10.1016/j.annemergmed.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kai-Hsiang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Yui-Rwei Young
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Di-You Guo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Kao-Chi Chang
- Department of Gastroenterology, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
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6
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Koshariya M, Khare V, Mishra S, Rathod R, Maggo S, Pandey S, Khan A, Tekam V, Mc S. Management of Duodeno-Jejunal Flexure Transection after Blunt Trauma - A Modified Approach. Chirurgia (Bucur) 2021; 116:1-7. [PMID: 34463243 DOI: 10.21614/chirurgia.116.ec.2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Small bowel injuries are infrequent after blunt trauma and typically affect fixed segment. Untimely management of such injuries, results in high-output entero-cutaneous fistula which increases morbidity and mortality. Treatment of duodeno-jejunal flexure transection has been traditionally done by pyloric exclusion with gastrojejunostomy, but more recent evidence suggests that end-to-end anastomosis or primary closure may be equally effective in which duodeno-jejunal anastomosis is protected via an external tube duodenostomy. Objective: The objective of the study is to provide a modification to the technique of management of duodeno-jejunal flexure injury, avoiding external tube duodenostomy. Material and Methods: Patients admitted from July 1, 2015 to June 1, 2018 were identified and examined for duodeno-jejunal flexure transection. Non-accidental injury cases were excluded. Results: In the study period, a total of 10 patients were admitted with duodeno-jejunal flexure transection. All cases were admitted 24 hours after the injury and presented with shock. After fluid resuscitation and investigations, they were taken for urgent laparotomy. The whole of duodenum was mobilised, the transected ends were debrided and end-to-end duodenojejunal anastomosis was performed in two-layer fashion. An 18-French Nasojejunal (NJ) tube was placed beyond the anastomosis, and an 18-French nasogastric (NG) tube was placed in the stomach for gastric decompression. A feeding jejunostomy was performed in all cases. Both NG and NJ tubes were removed after bowel movements started and FJ was removed on first follow up. There was no incidence of duodenum related complications, and all were doing well on follow up. Discussion and conclusion: Placing the nasojejunal and nasogastric tube eliminates the need for duodenostomy and gastrostomy, respectively. This method protects the duodeno-jejunal anastomosis and decreases the incidence of duodenum-related complications.
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Macoin E, Kintz P, Gressel A, Leyendecker P, Raul JS, Walch A. The Importance of Autopsy in a Case of Digestive Perforation Undetected by Postmortem Computed Tomography. Am J Forensic Med Pathol 2021; 42:201-204. [PMID: 32956075 DOI: 10.1097/paf.0000000000000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Cases of foreign body ingestion in the forensic literature are mainly described in children or psychiatric patients. Postmortem imaging can detect most foreign bodies, but its sensitivity depends, among other things, on the type of item and its location. In some cases, the ingestion of foreign bodies can remain unnoticed and have serious consequences for the patient. We describe the case of a patient who died in a psychiatric seclusion room with no obvious cause and for whom a forensic autopsy was requested. Further investigations showed the existence of a subdural hematoma associated with a midline shift, secondary to a skull fracture that was considered to be the cause of death. Toxicological analyses identified in blood several drugs, including diazepam (24 ng/mL) and its major metabolite nordazepam (24 ng/mL), propranolol (57 ng/mL), paliperidone (9 ng/mL), and loxapine (620 ng/mL). The forensic autopsy revealed the existence of a gastrointestinal perforation after the ingestion of a plastic teaspoon, which the postmortem CT scan had failed to detect. Although technological advances continue to assist the forensic pathologist in his diagnosis, autopsy still has a leading role in forensic investigations and does not yet seem to be replaceable by imaging techniques alone.
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Affiliation(s)
| | - Pascal Kintz
- Toxicology Laboratory at the Institute of Legal Medicine
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Ordoñez CA, Parra MW, Millán M, Caicedo Y, Padilla N, García A, Franco MJ, Aristizábal G, Toro LE, Pino LF, González-Hadad A, Herrera MA, Serna JJ, Rodríguez-Holguín F, Salcedo A, Orlas C, Guzmán-Rodríguez M, Hernández F, Ferrada R, Ivatury R. Damage control in penetrating duodenal trauma: less is better - the sequel. Colomb Med (Cali) 2021; 52:e4104509. [PMID: 34188326 PMCID: PMC8216054 DOI: 10.25100/cm.v52i2.4509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/16/2020] [Accepted: 04/28/2021] [Indexed: 11/11/2022] Open
Abstract
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - María Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Gonzalo Aristizábal
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Eduardo Toro
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Claudia Orlas
- Department of Surgery, Center for Surgery and Public Health, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston - USA
| | - Mónica Guzmán-Rodríguez
- Universidad de Chile, Facultad de Medicina, Instituto de Ciencias Biomédicas, Santiago de Chile, Chile
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery.Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
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Tokumaru T, Eifuku R, Sai K, Kurata H, Hata M, Tomioka J. Pediatric blunt abdominal trauma with horizontal duodenal injury in school baseball: A case report. Medicine (Baltimore) 2021; 100:e24089. [PMID: 33466171 PMCID: PMC10545394 DOI: 10.1097/md.0000000000024089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pediatric sports injuries, including those from baseball, most often are musculoskeletal injuries and rarely include blunt abdominal injuries. Duodenal injury is rare and often associated with other organ injuries. Because it has a relatively high mortality, early recognition and timely treatment are needed. Here, we report a case of successful treatment of a pediatric patient with duodenal injury incurred in the context of school baseball. PATIENT CONCERNS A 13-year-old boy suffered blunt abdominal trauma and a right-hand injury caused by beating his abdomen strongly with his own right knuckle after he performed a diving catch during a baseball game. On the following day, the abdominal pain had worsened. DIAGNOSES Computed tomography led to a suspicion of injury to the horizontal part of the duodenum. INTERVENTIONS The duodenal injuries were repaired by simple closure. On the 10th post-operative day, an abscess formed in the retroperitoneal cavity because of an occult pancreatic injury. Ultrasound-guided percutaneous drainage of the cavity was performed. OUTCOMES The post-operative course of the abscess drainage was uneventful. The patient was discharged from our hospital on day 72 after admission and was in good health at the 9-month follow-up. LESSONS Regardless of the type of injury, we must assess the life-threatening conditions that can be expected based on the mechanism of the injury. In duodenal injuries, it is critical to perform surgical procedures and post-operative management based on the assumption of injuries to other organs.
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Park Y, Kim Y, Lee J, Cho BS, Lee JY. Pancreaticoduodenal arterial hemorrhage following blunt abdominal trauma treated with transcatheter arterial embolization: Two case reports. Medicine (Baltimore) 2020; 99:e22531. [PMID: 33019457 PMCID: PMC7535771 DOI: 10.1097/md.0000000000022531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Although surgery has been the standard treatment for pancreaticoduodenal trauma because of the complex anatomical relation of the affect organs, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment. However, TAE for pancreaticoduodenal arterial hemorrhage (PDAH) can be challenging because it is difficult to localize the involved artery and to embolize the bleeding completely due to the abundant collateral channels of the pancreaticoduodenal artery (PDA). PATIENT CONCERNS Herein, we report 2 cases of PDAH that occurred after falling down in case 1 and a pedestrian traffic accident in case 2. DIAGNOSES Multidetector computed tomography scan revealed massive retroperitoneal hematoma with active extravasation of contrast media from the PDA without any duodenal perforation or advanced pancreatic injury in both patients. INTERVENTIONS All patients were successfully treated using only TAE with a combination of microcoils and n-butyl cyanoacrylate (NBCA) in case 1, and only NBCA in case 2. OUTCOMES There was no complication such as duodenal ischemia or pancreatitis. Laparotomy was not needed after TAE. LESSONS In selective PDAH cases, TAE may be a reasonable alternative to emergency laparotomy. It is expected that a careful and repetitive approach, based on complete angiography and embolization with a permanent liquid embolic agent such as NBCA could increase the success rate of TAE.
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Affiliation(s)
- Yeongtae Park
- Department of Radiology, Chungbuk National University Hospital
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital
- Department of Radiology, College of Medicine, Chungbuk National University
| | - Bum S. Cho
- Department of Radiology, Chungbuk National University Hospital
- Department of Radiology, College of Medicine, Chungbuk National University
| | - Jin Y. Lee
- Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
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11
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Trejo-Avila M, Valenzuela-Salazar C, Herrera-Esquivel JJ. Biliary stent-induced duodenal perforation. Rev Gastroenterol Mex (Engl Ed) 2020; 85:358-359. [PMID: 32336593 DOI: 10.1016/j.rgmx.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/11/2019] [Accepted: 01/14/2020] [Indexed: 06/11/2023]
Affiliation(s)
- M Trejo-Avila
- Departamento de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, Ciudad de México, México.
| | - C Valenzuela-Salazar
- Departamento de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, Ciudad de México, México
| | - J J Herrera-Esquivel
- Departamento de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, Ciudad de México, México
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12
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Wang X, Qu J, Li K. Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature. BMC Gastroenterol 2020; 20:149. [PMID: 32398025 PMCID: PMC7216602 DOI: 10.1186/s12876-020-01294-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic retrograde biliary drainage (ERBD) is the most frequently performed procedure for treating benign or malignant biliary obstruction. Although duodenal perforations secondary to the biliary plastic stent are quite rare, they can be life-threatening. The treatment strategies for such perforations are diverse and continue to be debated. CASE PRESENTATION We report three cases of duodenal perforation due to the migration of biliary plastic stents that were successfully managed using an endoscope. The three patients were admitted on complaints of abdominal pain after they underwent ERBD. Abdominal computerized tomography (CT) revealed migration of the biliary plastic stents and perforation of the duodenum. Endoscopy was immediately performed, and perforation was confirmed. All migrated stents were successfully extracted endoscopically by using snares. In two of the three cases, the duodenal defects were successfully closed with haemostatic clips after stent retrieval, and subsequently, endoscopic nasobiliary drainage tubes were inserted. After the endoscopy and medical treatment, all three patients recovered completely. CONCLUSIONS Duodenal perforations due to the migration of biliary stents are rare, and the treatment strategies remain controversial. Our cases and cases in the literature demonstrate that abdominal CT is the preferred method of examination for such perforations, and endoscopic management is appropriate as a first-line treatment approach.
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Affiliation(s)
- Xiaopeng Wang
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Junwen Qu
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Kewei Li
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China.
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13
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Yuan XL, Ye LS, Liu Q, Wu CC, Liu W, Zeng XH, Zhang YH, Guo LJ, Zhang YY, Li Y, Zhou XY, Hu B. Risk factors for distal migration of biliary plastic stents and related duodenal injury. Surg Endosc 2020; 34:1722-1728. [PMID: 31321537 PMCID: PMC7093356 DOI: 10.1007/s00464-019-06957-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The risk factors of duodenal injury from distal migrated biliary plastic stents remain uncertain. The aim of this study was to determine the risk factors of distal migration and its related duodenal injury in patients who underwent placement of a single biliary plastic stent for biliary strictures. METHODS We retrospectively reviewed all patients with biliary strictures who underwent endoscopic placement of a single biliary plastic stent from January 2006 to October 2017. RESULTS Two hundred forty-eight patients with 402 endoscopic retrograde cholangiopancreatography procedures were included. The incidence of distal migration was 6.2%. The frequency of duodenal injury was 2.2% in all cases and 36% in cases with distal migration. Benign biliary strictures (BBS), length of the stent above the proximal end of the stricture (> 2 cm), and duration of stent retention (< 3 months) were independently associated with distal migration (p = 0.018, p = 0.009, and p = 0.016, respectively). Duodenal injury occurred more commonly in cases with larger angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body (p = 0.018) or in cases with stent retention < 3 months (p = 0.031). CONCLUSIONS The risk factors of distal migration are BBS and the length of the stent above the proximal end of the stricture. The risk factor of duodenal injury due to distal migration is large angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body. Distal migration and related duodenal injury are more likely to present during the early period after biliary stenting.
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Affiliation(s)
- Xiang-Lei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Qin Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Chun-Cheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xian-Hui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu-Hang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lin-Jie Guo
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu-Yan Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xin-Yue Zhou
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Velez DR, Hustad L, Aaland MO, Maki CJ, Zreik K. Duodenal Injury in the Dakotas: A 15-Year Review of Duodenal Injury in the Level II Trauma Centers of North and South Dakota. Am Surg 2020; 86:e170-e172. [PMID: 32391767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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15
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Tokuhara T, Nakata E, Tenjo T, Kawai I, Kondo K, Hatabe S. Modified delta-shaped gastroduodenostomy consisting of linear stapling and single-layer suturing with the operator positioned between the patient's legs: A technique preventing intraoperative duodenal injury and postoperative anastomotic stenosis. PLoS One 2020; 15:e0230113. [PMID: 32142547 PMCID: PMC7059953 DOI: 10.1371/journal.pone.0230113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background The drawback of the delta-shaped gastroduodenostomy (DSG) in totally laparoscopic distal gastrectomy (TLDG) is the presence of intraoperative duodenal injury and postoperative anastomotic stenosis, which can occur due to a relatively short duodenal bulb diameter. Materials and methods From June 2013 to June 2019, 35 patients with gastric cancer underwent TLDG with a modified DSG consisting of linear stapling and single-layer hand suturing in our institution. All anastomotic procedures were performed by the right hand of the operator positioned between the patient’s legs. Linear stapling of the posterior walls of the remnant stomach and duodenum without creating a gap was performed using a 45-mm linear stapler, considering the prevention of intraoperative duodenal injury. The stapler entry hole was closed using a single-layer full-thickness hand suturing technique with knotted sutures and a knotless barbed suture. We described the clinical data and outcomes in the present retrospective patient series. Results No intraoperative duodenal injury occurred in any of the 35 patients. The median staple length at linear stapling of the posterior walls of the remnant stomach and duodenum was 41.7 ± 4.2 (30–45) mm, and 2 patients (5.7%) had a staple length of 30 mm. There were no incidences of postoperative anastomotic stenosis. Conclusions We suggest that a modified DSG consisting of linear stapling and single-layer hand suturing performed by an operator positioned between the patient’s legs can be one option for B-Ⅰ reconstruction following TLDG because it can aid in preventing both intraoperative duodenal injury and postoperative anastomotic stenosis.
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Affiliation(s)
- Takaya Tokuhara
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Eiji Nakata
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Toshiyuki Tenjo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Isao Kawai
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Keisaku Kondo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
| | - Shigeru Hatabe
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka, Japan
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16
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Wang VY, Wang VL, Kao L, Elwood DR. A Complex Game of Go Fish: A Hybrid Endoscopic and Surgical Approach to a Fish Bone Perforation of the Portal Vein. Am Surg 2020; 86:e153-e155. [PMID: 32223827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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17
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Park HO, Choi JY, Jang IS, Kim JD, Kim JW, Byun JH, Kim SH, Yang JH, Moon SH, Kim KN, Kang DH, Jung JJ, Choi SM, Kim JY, Lee CE. Perforation of inferior vena cava and duodenum by strut of inferior vena cava filter: A case report. Medicine (Baltimore) 2019; 98:e17835. [PMID: 31764778 PMCID: PMC6882657 DOI: 10.1097/md.0000000000017835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS We performed a laparotomy to remove the IVC filter. OUTCOMES Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.
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Affiliation(s)
- Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
| | - Jun Young Choi
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
| | - In Seok Jang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
| | - Jong Duk Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Ki Nyun Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Dong Hun Kang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon
| | | | - Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
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Holloway J, Lett E, Marcia L, Putnam B, Neville A, Patel N, Chong V, Kim DY. Primary Skin Closure after Repair of Hollow Viscus Injuries. Am Surg 2019; 85:1139-1141. [PMID: 31657310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender (P = 0.03) and base deficit were associated (P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs (P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.
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19
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Angelopoulos S, Ioannidis O, Mantzoros I, Pramateftakis MG, Kotidis E, Kitsikosta L, Kyriakidou D, Tsalis K. Duodenal Injuries During Laparoscopic Cholecystectomy: An Unusual But Serious Complication of a Routine Surgical Procedure. Chirurgia (Bucur) 2019; 114:518-521. [PMID: 31511138 DOI: 10.21614/chirurgia.114.4.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/23/2022]
Abstract
Duodenal injury is an unusual complication of laparoscopic cholecystectomy, mostly caused by direct injury of the duodenum by laparoscopic instruments, either mechanical or thermal. The management is usually surgical, with satisfactory results, as long as the complication is detected early. We report two cases of duodenal perforations during laparoscopic cholecystectomy.
One was treated with primary closure of the defect, while the other was managed conservatively with abdominal drainage and food deprivation. Both techniques proved successful in the management of that complication.
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20
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Snapshot quiz. Br J Surg 2019; 106:1137. [PMID: 31304576 DOI: 10.1002/bjs.11134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW The gastroduodenal mucosal layer is a complex and dynamic system that functions in an interdependent manner to resist injury. We review and summarize the most updated knowledge about gastroduodenal defense mechanisms and specifically address (a) the mucous barrier, (b) membrane and cellular properties, and vascular, hormonal, and (c) gaseous mediators. RECENT FINDINGS Trefoil factor family peptides play a crucial role in cellular restitution by increasing cellular permeability and expression of aquaporin channels, aiding cellular migration and tissue repair. Additionally, evidence suggests that the symptoms of functional dyspepsia may be attributed to alterations in the duodenum, including low-grade inflammation and increased mucosal permeability. The interaction of the various mucosal protective components helps maintain structural and functional homeostasis. There is increasing evidence suggesting that the upper GI microbiota plays a crucial role in the defense mechanisms. However, this warrants further investigation.
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Affiliation(s)
- Gian M Galura
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Luis O Chavez
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Alejandro Robles
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | - Richard McCallum
- Department of Gastroenterology, Texas Tech University Health Science Center, El Paso, TX, USA.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, NO. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China
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24
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Vercruysse GA, Bauman ZM, Hennemeyer CT, Devis P, Rhee PM. Man Lured with Alcohol, Takes Bait, and Gets Caught: A Cautionary Fish Tale. Am Surg 2018; 84:e85-e86. [PMID: 30454489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Gary A Vercruysse
- Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA
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25
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Siddiq M, Qureshi AU, Farooq MS, Ali AA. Duodenal Perforation due to Ingested Partial Denture. J Coll Physicians Surg Pak 2017; 27:778-779. [PMID: 29185407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Ingestion of foreign bodies including dentures can be a cause of morbidity and mortality. We report a case of poor-fit denture in an elderly male with pulmonary and musculoskeletal comorbidities, who presented as an acute abdomen. The pin attached to the denture caused perforation of first part of duodenum. The only positive finding prior to surgery was a radiopaque density in the abdominal radiograph of the patient and air under the diaphragm. It is important for all the surgeons dealing with acute care patients to be aware of different designs and constructions of dentures.
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Affiliation(s)
| | | | | | - Abrar Ashraf Ali
- Department of General Surgery, King Edward Medical University, Lahore
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26
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Feliciano DV. Abdominal Trauma Revisited. Am Surg 2017; 83:1193-1202. [PMID: 29183519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.
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27
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Beriashvili Z, Gurgenidze M. TREATMENT OF DUODENAL INJURIES AND COMPLICATIONS AFTER SURGERY (CASE REPORTS). Georgian Med News 2017:24-29. [PMID: 29099696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 28-year-old male patient came to Surgical Department 15.07.2003 after a gunshot wound. An emergency operation was performed. Among the other damages of different part of intestinum damage of the anterior wall of the second anatomical part of the duodenum was diagnosed intraoperatively. The size of the damaged area was 3×1 sm. The doudenal wound was sutured with two layers after updating the edges. On the fifth postoperative day the wound leakage was detected. Later the giant sizes of duodenal fistula was formed. It opened on the anterior wall of the abdomen. After patients proper preparation there was performed the operation after 6 months of initial operation. Operative access was laparotomy from right pararectal incision. The mobilization of the edges of this fistula was performed without entering the abdominal cavity. The first loop of the jejunum was constructed in Roux-an-Y form. There was formed subcutaneous canal and distal part of Roux-an-Y type constructed jejunum was passed through it. There was performed mobilization of the edges of anterior part of aponeurosis of the rectus muscle sheath nearby of the fistula. End-to-End anastomosis was performed between fistula and Roux-an-Y type constructed jejunum. Postoperative period passed without complications. A 45-year-old male patient came to Surgical Department 26.11.1992 after a car accident. After different types of investigations was diagnosed damage of the retroperitoneal wall of the third part of the duodenum. The size of the wound was 2×1 sm. An urgent operation was performed. After Cocher's maneuver a wound was found and sutured. On the postoperative day 4 passage of the duodenal content through the drainage was detected. Retroperitoneal phlegmon with severe intoxication was diagnosed. In reoperation duodenotomy was performed proximally to the damaged area. Duodenum was ligated distally from papilla Vateri. There was performed anastomosis proximally from the ligature between already formed duodenotomy area and distal part of jejunum constructed in Roux-an-Y form. The patient's condition improved the second day after surgery. Thus, according to our experience, there are no standard solutions of treatment of duodenal injuries and postoperative complications. In both cases we adopted non-standard decisions. In accordance with the received good results, we may recommend described operations as the acceptable treatment methods in specific cases.
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Affiliation(s)
- Z Beriashvili
- 1Critical Care Medicine Institute, Tbilisi; Ivane Javakhishvili Tbilisi State University, Department of Surgery; 2The First University Clinic of Tbilisi State Medical University, Department of General Surgery, Tbilisi State Medical University, Department of Surgery № I, Georgia
| | - M Gurgenidze
- 1Critical Care Medicine Institute, Tbilisi; Ivane Javakhishvili Tbilisi State University, Department of Surgery; 2The First University Clinic of Tbilisi State Medical University, Department of General Surgery, Tbilisi State Medical University, Department of Surgery № I, Georgia
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28
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Irisarri Garde R, Vila Costas JJ. Duodenal hematoma caused by endoscopic hemostatic procedures (sclerotherapy). Rev Esp Enferm Dig 2017; 109:666. [PMID: 28689427 DOI: 10.17235/reed.2017.4883/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Endoscopic hemostatic procedures such as local injection of epinephrine are commonly used for the treatment of bleeding ulcers. Although the risks are usually considered to be minimal, there are reports describing that duodenal intramural hematomas may develop as a complication after endoscopy especially in patients susceptible to hemorrhage such as those with anticoagulants therapy or blood dyscrasia.
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Turaihi H, Assam J, Zanfes J, Thambi-Pillai T. Laparoscopic Treatment of a Pyogenic Hepatic Abscess Caused by Transmural Duodenal Perforation of a Toothpick. S D Med 2017; 70:369-371. [PMID: 28813745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The development of pyogenic hepatic abscess resulting from perforation of the gastrointestinal tract is a rare pathologic finding. It is a condition that can be fatal making early detection and subsequent removal of the inciting foreign body critical to avoid more deleterious sequela. Yet, its initial presentation tends to be nonspecific and typically is only discovered once surgical investigation into the cause of persisting abscess formation is performed. In this study, laparoscopic treatment of a 52-year-old male with a non-resolving hepatic abscess due to transmural gastrointestinal perforation of a toothpick is presented. Although a rare finding, reports of foreign body induced hepatic abscess have recently increased in the world literature, allowing some preliminary efforts in proposing diagnostic characterization. Yet, more case studies will be required to permit validation of these findings making continued reporting of this pathologic process critical.
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Affiliation(s)
- Hassan Turaihi
- Department of Surgery, University of South Dakota Sanford School of Medicine
| | - Jed Assam
- University of South Dakota Sanford School of Medicine
| | - Justin Zanfes
- University of South Dakota Sanford School of Medicine
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30
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Affiliation(s)
- Mark McKelvie
- University of Cambridge School of Clinical Medicine, Cambridge, UK
- Bedford Hospital NHS Trust, Bedford, UK
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Gong K, Guo S, Wang K. [Diagnosis and treatment of duodenal injury and fistula]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:266-269. [PMID: 28338158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
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Affiliation(s)
- Kunmei Gong
- Department of General Surgery, The First People's Hospital of Yunnan Province, Kunming 650032, China
| | - Shikui Guo
- Department of General Surgery, The First People's Hospital of Yunnan Province, Kunming 650032, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, China.
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Abstract
We present a case in which the accidental ingestion of a toothpick caused duodenal perforation and small intestinal obstruction. A 58-year-old man visited our emergency room with acute abdominal pain. Computed tomography (CT) showed obstructive ileus as well as a foreign body penetrating the duodenum, which was identified as a toothpick and removed endoscopically. Unenhanced CT was superior in detecting the object. The patient has been doing well since the operation.
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Affiliation(s)
- Junichi Izumi
- Department of Radiology, Yokote Municipal Hospital, Japan
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33
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Serrano OK, Solsky I, Sandoval E, Berlin A, Bellemare S. Draining T-Tube Jejunostomy: A Technique to Get Out of Trouble. Am Surg 2016; 82:522-525. [PMID: 27305884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A perforated viscus in the postpancreaticoduodenectomy setting is a rare phenomenon and a devastating complication. In this situation, adherence to damage-control principles demands minimizing the operative intervention while addressing the intestinal perforation as a way to mitigate the injurious effects on a complex gastrointestinal reconstruction. Herein, we describe our intraoperative decision-making with an unconventional approach in the management of a perforated viscus in the postpancreaticoduodenectomy setting using a draining T-tube jejunostomy. Our patient recovered remarkably well from this and was discharged from the hospital in six days with a controlled draining T-tube jejunostomy, which was subsequently removed on postoperative day 35. Our case illustrates an important option when dealing with a perforated viscus in the complex gastrointestinal surgery patient that has minimal morbidity, adequate source control, and the potential for an excellent clinical outcome. As surgical care continues to be delivered in a specialty-driven manner, a draining T-tube jejunostomy presents the ideal technique to get out of trouble for the general surgeon practicing in the community who may not be as experienced with complex gastrointestinal surgery.
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Affiliation(s)
- Oscar K Serrano
- Montefiore Center for Cancer Care, Montefiore Medical Center, New York, USA
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Ahmad R, Shafique MS, Ul Haq N, Akram Z, Qureshi U, Khan JS. Isolated Duodenal Injuries After Blunt Abdominal Trauma. J Ayub Med Coll Abbottabad 2016; 28:400-403. [PMID: 28718573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Isolated duodenal injury after blunt abdominal trauma is a very rare entity. In contrast to penetrating injuries, duodenal injuries after blunt trauma are difficult to diagnose. Early diagnosis and management is required to prevent high morbidity and mortality associated with these injuries. We present three young patients of blunt abdominal trauma with an isolated injury to duodenum in which primary repair of perforations were done with good outcomes.
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Affiliation(s)
- Raheel Ahmad
- Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | | | - Najibul Ul Haq
- Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Zohra Akram
- Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Usman Qureshi
- Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
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Krzesiek E, Iwańczak B, Zaleska-Dorobisz U, Patkowski D. [Intramural duodenal hematoma and acute pancreatitis as a complication of diagnostic biopsy of a duodenal 6-year-old boy]. Dev Period Med 2016; 20:134-138. [PMID: 27442698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hematoma duodenum is a very rare complication of diagnostic endoscopy of the upper gastrointestinal tract when biopsy of the duodenum is performed (average frequency is estimated as 1:1,250 biopsies). Most often, it affects children and young adults without any risk factors. Symptoms result from obstruction of the duodenum and compression of the adjacent structures. Conservative treatment, which consists of parenteral nutrition and aspiration of gastric contents until the absorption of hematoma and patency of the gastrointestinal tract returns, is preferred. This paper describes a 6-year-old boy diagnosed due to short stature and low weight in whom the diagnostic biopsy of the duodenum caused formation of a hematoma in the descending duodenum and led to total ileus and acute pancreatitis. The boy was treated conservatively with good result and complete resolution of symptoms was achived.
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Affiliation(s)
- Elżbieta Krzesiek
- II Katedra i Klinika Pediatrii, Gastroenterologii i Żywienia UM we Wrocławiu, ul. Skłodowskiej-Curie 50/52, 50-369 Wrocław tel. (+48 71) 770-30-45 fax (+48 71) 770-30-46 e-mail:
| | - Barbara Iwańczak
- II Katedra i Klinika Pediatrii, Gastroenterologii i Żywienia UM we Wrocławiu
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Affiliation(s)
- John Hansen-Flaschen
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Jimenez-Fuertes M, Moreno-Posadas A, Ruíz-Tovar Polo J, Durán-Poveda M. Liver abscess secondary to duodenal perforation by fishbone: Report of a case. Rev Esp Enferm Dig 2016; 108:42. [PMID: 26765235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Liver abscesses usually arise from amoebian or bacterial origin, being rarely secondary to foreign bodies (1-3). We report the case of a 72-years-old female complaining from abdominal pain located in epoigastrium and right hypochondrium during the last 48 hours. Laboratory data revealed leukocytosis with neutrophilia and pain located in the mentioned locations at physical examination. Ultrasonography showed a liver abscess involving segments 2 and 3. CT scan revealed that the abscess was secondary to a fishbone perforating the duodenum and inlaid in the liver (Figure 1). The fishbone was surgically extracted from the hepatic lobe with hemostasia and a duodenal suture with epiploplastia was performed. Antibiotic was added to the treatment. The patient presented an uneventful postoperative course. The intake of foreign bodies is a frequent event, representing bones and fishbones the most frequent foreing bodies in the adults. Sometimes, the diagnosis may be difficult because the symptoms are not specific. Imaging test are very usefol for the diagnosis, as in the case we present.
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Yang HY, Chen JH. Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography. World J Gastroenterol 2015; 21:12976-12980. [PMID: 26668519 PMCID: PMC4671050 DOI: 10.3748/wjg.v21.i45.12976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/05/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Traditionally, perivaterian duodenal perforation can be managed conservatively or surgically. If a large volume of leakage results in fluid collection in the retroperitoneum, surgery may be necessary. Our case met the surgical indication for perivaterian duodenal perforation after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation. The patient developed a retroperitoneal abscess after the procedures, and a perivaterian perforation was suggested on computed tomography (CT). CT-guided abscess drainage was performed immediately. We unsuccessfully attempted to close the perforation with hemoclips initially. Subsequently, we used fibrin sealant (Tisseel) injection to occlude the perforation. Fibrin sealant injections have been previously used during endoscopy for wound closure and fistula repair. Based on our report, fibrin sealant injection can be considered as an alternative method for the treatment of ERCP-related type II perforations.
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Siboni S, Benjamin E, Haltmeier T, Inaba K, Demetriades D. Isolated Blunt Duodenal Trauma: Simple Repair, Low Mortality. Am Surg 2015; 81:961-964. [PMID: 26463289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and nonduodenal intra-abdominal Organ Injury Scale ≥ 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS (P = 0.004) and similar mortality (P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE.
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Affiliation(s)
- Stefano Siboni
- Division of Trauma and Acute Care Surgery, Los Angeles County Medical Center, University of Southern California, Los Angeles, California, USA
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Tumay V, Guner OS, Meric M, Isik O, Zorluoglu A. Endoscopic Removal of Duodenal Perforating Fishbone - A Case Report. Chirurgia (Bucur) 2015; 110:471-473. [PMID: 26531793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accidental ingestion of foreign bodies is common in clinical practice. While perforation of the ileum and jejunum due to the ingested foreign body is common, duodenal perforation is rare. In this report, our experience with this rare entity is shared. CASE REPORT Here we present a 31-year-old patient with gastrointestinal tract perforation at the second part of the duodenum due to an ingested fishbone. The patient was admitted to the emergency room with abdominal pain. Right upper quadrant tenderness was detected at physical examination, and leukocytosis on the laboratory test results. Ultra-sonography was not diagnostic, however, computerized tomo-graphy showed an ingested foreign body in the second part of the duodenum. A fishbone perforating the duodenum was retrieved by endoscopy. The patient was managed non-operatively, and discharged without any problems on the third day after endoscopy. CONCLUSION Endoscopic removal and non-operative management may be feasible in carefully selected patients with duodenal perforated fishbone ingestion.
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Hong J, Wang SY, Qian L, Chen ZY. Diagnosis and Treatment of Duodenal Injury: A Clinical Analysis. Hepatogastroenterology 2015; 62:641-646. [PMID: 26897945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIMS Duodenal injuries do not often occur and are usually difficult to be diagnosed or treated. METHODOLOGY To summarize the experience in managing duodenal injuries and determine some prognostic factors, we conducted a retrospective review on 42 cases of duodenal injuries including 17 traumatic (blunt 31.0%, penetrating 9.5%) and 25 iatrogenic (59.5%) ones, which were admitted to our hospital from 1993 to 2013. RESULTS The mortality rate was 23.8% (n = 10). Main cause of late death was multiple system organ failure and infection. Senility and high APACHE II score were both correlated with mortality rate (P < 0.01 and P < 0.05 respectively). High morbidity and mortality rate were more likely to be associated with those had long delays in treatment or injury in the second part of the duodenum (P < 0.05). The number of associated injuries affected mortality rate (P < 0.05). For traumatic injuries, the mechanism of injury, method of initial surgical management, Organ Injury Scale and Abbreviated Injury Scale were not related to patients' outcome (P > 0.05). CONCLUSIONS These findings indicated that early diagnosis and timely treatment were of great clinical value. Primary repair with an effective diversion was practicable. Age and APACHE II Score were the independent prognostic factors.
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Green JM, Avery MJ, Sing RF. Safe endovascular retrieval of a vena cava filter after duodenal and pancreatic perforation and associated recurrent pancreatitis. Am Surg 2015; 81:E188-E189. [PMID: 25975304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- John M Green
- Carolinas Health Care System, Charlotte, North Carolina, USA
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Yilmaz B, Roach EC, Koklu S, Aydin O, Unlu O, Kilic YA. Air leak syndrome after endoscopic retrograde cholangiopancreatography: A rare and fatal complication. World J Gastroenterol 2015; 21:4770-4772. [PMID: 25914490 PMCID: PMC4402328 DOI: 10.3748/wjg.v21.i15.4770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/28/2014] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a state of the art diagnostic and therapeutic procedure for various pancreatic and biliary problems. In spite of the well-established safety of the procedure, there is still a risk of complications such as pancreatitis, cholangitis, bleeding and perforation. Air leak syndrome has rarely been reported in association with ERCP and the optimal management of this serious condition can be difficult to establish. Our group successfully managed a case of air leak syndrome following ERCP which was caused by a 3cm Stapfer type I perforation in the posterolateral aspect of the second part of the duodenum and was repaired surgically. Hereby, we describe the presentation and subsequent therapeutic approach.
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Kowalewski P, Najdecki ME, Trojanowski P, Paśnik K. [Retroperitoneal perforation of duodenum - surgical approach]. Pol Merkur Lekarski 2015; 38:219-221. [PMID: 25938390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Retroperitoneal perforation of the duodenum, caused by abdominal trauma, endoscopic examination or diverticulitis, is a serious clinical problem, because of it's lack of specific symptoms. Surgical treatment is often performed in sepsis. That is why the knowledge of adequate techniques is crucial for surgeons. We would like to present our model of surgical approach, based on several trauma center's cases. Among the methods and techniques presented we emphasize the duodenal by-pass with bile duct drainage. Post-op cases of gastrojejunal anastomosis' bleeding prompt to implement a selective vagotomy, which however requires further studies.
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Affiliation(s)
- Piotr Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
| | - Marek E Najdecki
- Department of General, Oncological, Metabolic and Thoracic Surgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
| | - Piotr Trojanowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Poland
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O’Reilly DA, Bouamra O, Kausar A, Dickson EJ, Lecky F. The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989-2013. Ann R Coll Surg Engl 2015; 97:125-30. [PMID: 25723689 PMCID: PMC4473389 DOI: 10.1308/003588414x14055925060712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Pancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989-2013. METHODS The Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both. RESULTS Of 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14-35) for blunt trauma and 14 (IQR: 9-18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation. CONCLUSIONS Isolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.
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Affiliation(s)
- DA O’Reilly
- Department of HPB Surgery, North Manchester General Hospital, Manchester, UK
- Trauma Audit & Research Network (TARN), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - O Bouamra
- Trauma Audit & Research Network (TARN), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- EMRiS, Health Service Research, School of Health and Related Research, University of Sheffield
| | - A Kausar
- Department of HPB Surgery, North Manchester General Hospital, Manchester, UK
| | - EJ Dickson
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, UK
| | - F Lecky
- Trauma Audit & Research Network (TARN), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- EMRiS, Health Service Research, School of Health and Related Research, University of Sheffield
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Albin JS, Dunn EL. Ruptured duodenal diverticulum after blunt abdominal trauma. Am Surg 2015; 81:E111-E112. [PMID: 25760184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) represents a monumental advance in the management of patients with pancreaticobiliary diseases, but is a complex and technically demanding procedure with the highest inherent risk of adverse events of all routine endoscopic procedures. Overall adverse event rates for ERCP are typically reported as 5-10%. The most commonly reported adverse events include post-ERCP pancreatitis, bleeding, perforation, infection (cholangitis), and cardiopulomary or "sedation related" events. This article evaluates patient-related and procedure-related risk factors for ERCP-related adverse events, and discusses strategies for the prevention, diagnosis and management of these events.
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Affiliation(s)
- Tarun Rustagi
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06520, USA
| | - Priya A Jamidar
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06520, USA.
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Keskinen H, Hurme T. [Insidious duodenal injury in a child]. Duodecim 2015; 131:480-483. [PMID: 26237911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Duodenal injuries in children are rare. However, we should keep in mind the possibility of duodenal injury in blunt abdominal trauma. Findings on imaging can be normal in spite of duodenal perforation and symptoms may become manifest later after trauma. Duodenal perforation diagnosed within 24 hours can be treated with primary closure and drainage. The safest operative treatment is pyloric exclusion or duodenal diverticularization and gastrojejunostomy or pancreaticoduodenectomy in most serious injuries. Delay in diagnosis is associated with increased complication rate, hospitalization and mortality.
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van der Wilden GM, Yeh DD, Hwabejire JO, Klein EN, Fagenholz PJ, King DR, de Moya MA, Chang Y, Velmahos GC. Trauma Whipple: do or don’t after severe pancreaticoduodenal injuries? An analysis of the National Trauma Data Bank (NTDB). World J Surg 2014; 38:335-40. [PMID: 24121363 DOI: 10.1007/s00268-013-2257-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy for trauma (PDT) is a rare procedure, reserved for severe pancreaticoduodenal injuries. Using the National Trauma Data Bank (NTDB), our aim was to compare outcomes of PDT patients to similarly injured patients who did not undergo a PDT. METHODS Patients with pancreatic or duodenal injuries treated with PDT (ICD-9-CM 52.7) were identified in the NTDB 2008–2010 Research Data Sets. We excluded those who underwent delayed PDT (>4 days). The PDT group (n = 39) was compared to patients with severe combined pancreaticoduodenal injuries (grade 4 or 5) who did not undergo PDT (non-PDT group, n = 38). Patients who died in the emergency department or did not undergo a laparotomy were excluded. Our primary outcome was death. Secondary outcomes were intensive care unit length of stay (LOS), hospital LOS, and total ventilator days. A multivariate model was used to determine predictors of in-hospital mortality within each group and in the overall cohort. RESULTS The non-PDT group had a significantly lower systolic blood pressure and Glasgow Coma Scale values at baseline and more severe duodenal, pancreatic, and liver injuries. There were no significant differences in outcomes between the two groups. The Injury Severity Score was the only independent predictor of mortality among PDT patients [odds ratio (OR) 1.12, 95 % confidence interval (CI) 1.01–1.24] and in the entire cohort (OR 1.06, 95 % CI 1.01–1.12). The operative technique did not influence any of the outcomes. CONCLUSIONS Compared to non-PDT, PDT did not result in improved outcomes despite a lower physiologic burden among PDT patients. More conservative procedures for high-grade injuries of the pancreaticoduodenal complex may be appropriate.
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Ziaian B, Hosseinzadeh M, Nikravesh B, Roshanravan R, Rahimikazerooni S, Safarpour AR, Moslemi S. Assessing two methods of repair of duodenal defects, jejunal serosal patch and jejunal pedicled flap, (an experimental animal study). J PAK MED ASSOC 2014; 64:907-910. [PMID: 25252516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the outcomes of jejunal serosal patch and jejunal pedicled flap procedures for the repair of duodenal injuries. METHODS The experimental animal-model study was conducted at Shiraz University of Medical Sciences, Iran, in February 2013. Ten mixed-breed male dogs were selected and randomly divided into groups A and B. After general anaesthesia, a large duodenal defect was created in all animals. The defect was repaired with jejunal pedicled flap in group A and jejunal serosal patch in group B. Microscopic healing was scored according to epithelialisation, collagenisation, inflammation, ulcer and necrosis of samples. Kolmogorov-Smirnov and independent t-test were used to indicate normal distributions of data and statistical differences between the two groups respectively. RESULTS The weight of the animals ranged between 23 and 37 kg and the age range was 12-16 months. All dogs survived the procedures. Anastomotic leakage, intra-abdominal abscess or intestinal obstructions were not detected in gross examination. Healing score was significantly higher in the group A than group B (p < 0.011). However, in terms of surgical findings, no significant difference was detected between the groups (p > 0.05). CONCLUSION Applying jejunal pedicled flap for repairing large duodenal defects would lead to better histologic outcomes compared to jejunal serosal patch in dogs.
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