Penetrating traumatic injuries of the duodenum : experiences form al-yarmouk teaching hospital, baghdad

Abstract EN

Background : Duodenal injury following penetrating trauma remains one of the most challenging problems confronting trauma surgeons.

Experiance in trauma specially for penetrating injuries has increased in the last few years with accompanying increase in mortality.

Methods : Twenty seven patients with penetrating duodenum trauma, collecting from September 2005 to November 2007, evaluated according to the age, gender, types of injury, trauma location, severity of duodenal injury, associated injury, interval between trauma and definitive operation, hemodynamic status, surgical procedure, postoperative complication and mortality.

Injuries according to Trauma and injury severity score (TRISS) and penetrating trauma abdominal index (PATI) were evaluated.

Result : Bullets injury were 23 (85.2 %) patients and blast injury (shell) 4 (14.8 %) patients.

The mean PATI score was 30.2 (15-90) ; low score 44.4 %, intermediate score 37 % and high score 18.6 %.

Multiple organ injury in 26 patients and one with duodenum injured only.

The mean TRISS was 11.55 (1.5-90).

Primary repair with pyloric exclusion (with or without by pass surgery) or other type of surgery were performed.

Male to female incidence was 4 : 1 and mean age 27.6 year (9-60 yr.).

Complications were evaluated and the mortality were 11 (40.7 %) with low score of PATI 2 (16.6 %), intermediate score is 4 (40 %) and high score5 (100 %).

Conclusion : Experience suggests that duodenum injury still causing high morbidity and mortality in trauma.

The predictive value of the PATI suggests that it should be included along with other injury severity indices in trauma data bases.

Different surgical procedures needed to perform duodenum repair according to the type and site of injury.