Management of Blunt Duodenal Injuries
Suvit Sriussadaporn MD*, Rattaplee Pak-art MD*, Sukanya Sriussadaporn MD*, Kritaya Kritayakirana MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Chulalongkorn University
Background/Aims : Blunt duodenal injuries are relatively rare. Diagnosis is usually delayed resulting in
significant morbidity and mortality. Treatment of the injured duodenum varies according to severity of injury
and duration before diagnosis. Duodenal fistulas are serious complications with potential mortality. The
purpose of this study was to examine results of treatment of patients with blunt duodenal injuries at our
institution.
Patients and Method : This is a retrospective study of patients who sustained blunt duodenal injuries and
were admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1990 to Decem-
ber 2003. During the study period, management of duodenal injuries at our institution depended largely on
severity of injuries, timing of diagnosis and the presence of retroperitoneal infections. Intramural hematoma
of the duodenum was treated conservatively. Uncomplicated wounds of the duodenum (grade II and grade III
injury) with no obvious retroperitoneal infections were treated by simple duodenal repair. Pyloric exclusion
was performed in cases of difficult duodenal repair and/or delayed diagnosis (> 24 hours after injury) with
obvious evidence of retroperitoneal infections.
Results : Twenty six patients were entered into the study. Five patients (19.2%) had intramural hematoma of
the duodenum, all were successfully treated by conservative treatment. Twenty one patients (80.8%) had
transmural tear of the duodenal wall. Ten of them (47.6%) underwent simple repair, 10 (47.6%) underwent
simple repair of the duodenal wounds combined with pyloric exclusion (2 of them underwent the operations
elsewhere), and 1 (4.8%) underwent pancreaticoduodenectomy. Seven patients who had transmural tear of
the duodenum developed complications (33.3%). Two patients had duodenal fistulas (9.5%); 1 in the simple
repair group and 1 in the pyloric exclusion group. One patient who underwent pyloric exclusion had
leakage of the gastrojejunostomy anastomosis with intact duodenal repair resulting in a complicated and
prolonged hospital course. There was no mortality in this study.
Conclusions : The outcome in management of blunt duodenal injuries at our institution was acceptable with
low morbidity and no mortality. Intramural hematomas were safely treated conservatively. Uncomplicated
duodenal wounds were treated by simple suture repair. Pyloric exclusion was a useful additional procedure
in patients with complicated duodenal injuries. Retroperitoneal infections was a strong indication to per-
form this procedure in addition to simple repair of the duodenal wounds. Pancreaticoduodenectomy should
be reserved for only severed combined duodenal and pancreatic head injuries.
Keywords : Blunt duodenal injury, Duodenal fistula, Pyloric exclusion, Pancreaticoduodenectomy
