RT Book, Section
A1 Ferrada, Paula
A1 Ferrada, Ricardo
A1 Feliciano, David V.
A2 Feliciano, David V.
A2 Mattox, Kenneth L.
A2 Moore, Ernest E.
SR Print(0)
ID 1175138568
T1 Duodenum and Pancreas
T2 Trauma, 9e
YR 2020
FD 2020
PB McGraw Hill
PP New York, NY
SN 9781260143348
LK accesssurgery.mhmedical.com/content.aspx?aid=1175138568
RD 2023/03/31
AB KEY  POINTSThe  incidence  of  injuries  to  the  duodenum  at  laparotomy  is  <2%  with  stab  wounds,  5%  to  6%  with  blunt  trauma,  and  10%  to  11%  with  gunshot  wounds.A  patient  with  a  blunt  rupture  of  the  duodenum  may  have  minimal  symptoms  initially  due  to  its  retroperitoneal  location,  low  bacterial  count,  and  neutral  pH  contents.A  computed  tomography  (CT)  diagnosis  of  a  ruptured  duodenum  is  suggested  by  air  outside  the  duodenum  in  the  right  upper  quadrant  on  the  “scout”  film  and  leakage  of  contrast  on  the  formal  study.A  primary  transverse  or  oblique  suture  repair  of  a  blunt  rupture  or  penetrating  wound  of  the  duodenum  is  appropriate  if  there  is  no  loss  of  tissue  and  no  injury  to  the  major  papilla.Pyloric  exclusion  with  gastrojejunostomy  should  be  considered  as  an  adjunct  to  a  duodenal  repair  when  the  repair  narrows  the  duodenum,  the  duodenal  wall  around  the  repair  is  severely  contused,  there  has  been  a  delay  in  diagnosis  of  the  duodenal  injury,  or  there  are  adjacent,  but  not  destructive,  injuries  to  the  C-loop  and  head  of  the  pancreas.The  incidence  of  injuries  to  the  pancreas  at  laparotomy  is  approximately  6%  with  all  forms  of  trauma.When  a  contrast-enhanced  multidetector  CT  study  is  unclear  about  whether  an  injury  to  the  duct  of  Wirsung  is  present  after  blunt  trauma,  a  magnetic  resonance  cholangiopancreatography  and/or  an  endoscopic  retrograde  cholangiopancreatography  is  performed.The  Letton-Wilson  Roux-en-Y  distal  pancreatojejunostomy  is  appropriate  in  a  highly  selected  group  of  patients  with  Organ  Injury  Scale  proximal  grade  III  and  grade  IV  injuries.A  damage  control  approach  (sequential  operations)  is  now  used  in  the  majority  of  patients  who  need  a  pancreatoduodenectomy  after  trauma.Combined  pancreatoduodenal  injuries  have  significantly  increased  postoperative  complications  and  mortality  rates  when  compared  to  injury  to  either  organ  alone.