The Pattern and Optimal Surgical Treatment of High – Velocity Penetrating Duodenal Injuries

I .Razzouki, Haqqi

	The Pattern and Optimal Surgical Treatment of High – Velocity Penetrating Duodenal Injuries
Mustansiriya Medical Journal
Article 1, Volume 9, Issue 1, 2010, Pages 17-20
Author
Haqqi I .Razzouki
Abstract
Background The increased incidence of high velocity missile (H.V.M.)abdominal injuries in Iraq had been associated with an increase in the incidence of duodenal injuries. Setting Second and fourth surgical units at Al-Yarmouk Teaching Hospital. Objective To study the pattern of duodenal injuries, evaluate the proper surgical methods of duodenal injury management, to minimize the morbidity & mortality rates. Patients &methods Prospective study of forty two duodenal injury patients in 6 years period between Jan. 2003 – Dec. 2008 managed surgically. For Grade 2 duodenal injury we did primary repair with tube drainage, for grade 3; primary repair with tube duodenostomy or primary repair with triple ostomies, or primary repair with Pyloric exclusion and gastro-jejunostomy. Results Four hundred six laparatomy for (H.V.M.)abdominal injury, of these 42 cases (10.3%)associated with duodenal injury. 80% 35 male & 20% 7 female aged between (10-50)years with mean age of 32. There were no isolated duodenal injury, 43.8% had haemorragic shock on admission to the emergency room, 14 cases 33.3% died perioperatively, 4 cases 9.5% died postoperatively due to complications, no death in patients after leaving hospital. Conclusions Second part of the duodenum is the most common site of injury. Grade 3 duodenal injury has high morbidity & mortality rate. Time interval between the injury & operation is more important to decrease morbidity & mortality rate.

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