Management and outcomes of penetrating duodenal injuries: a retrospective cohort study from a level I trauma centre

Abstract

Background: Duodenal injuries are infrequent occurrences in traumatic abdomen.¹ Most common cause of duodenal trauma are gunshot wounds and stab injuries.¹ The purpose of this study is to determine the surgical outcome of penetrating duodenal injuries focusing on duodenal leakage.

Methods: A retrospective chart review with a descriptive-analytical design analysed medical records of 36 patients meeting inclusion criteria from a 966-patient database with penetrating abdominal trauma, admitted to Groote Schuur Hospital trauma centre, Cape Town, South Africa, over 72 months (2014–2019). Demographic data (age, sex), preoperative assessments, operative interventions, and postoperative complications were recorded, with complications graded using the Clavien-Dindo classification.

Results: Out of 966 patients admitted during the study period with penetrating abdominal trauma, 36 (3.73%) had penetrating duodenal injuries. All 36 patients were male, with a mean age of 27.17 (SD 8.28) years. Thirty-three (91.67%) patients sustained gunshot wounds, and the remaining three (8.33%) had stab wounds. Fifteen (41.67%) patients underwent damage control surgery (DCS). Six (16.67%) patients developed a duodenal leak (DL). Ten (27.78%) patients died, including five DL patients, who died due to sepsis.

Conclusion: Simple duodenal repair appears to be the best management option for penetrating duodenal injuries, except for severe injuries graded AAST IV-V where adjunct surgical techniques may be necessary.