Management of duodenal wounds

摘要: A 30-year experience with 321 wounds of the duodenum was reviewed. Of total, 302 had some form perforation; 19 intramural hematomas. All patients underwent laparotomy shortly after admission except six cases radiographically diagnosed submucosal hematoma. Occasional dehiscence duodenal suture line and its life-threatening complications (six 52 cases, or 12%) led to a policy routine decompression by gastrostomy plus twin jejunostomies in 1962. Following use latter technique 237 patients, only one leak occurred. By contrast, failure decompress an 8% rate; direct drainage gave even greater incidence fistula, 23%. Associated pancreatic injuries were treated as separate sump distal pancreatectomy. None three subjected pancraticoduodenectomy for massive combined trauma survived. long-armed T-tube always inserted recognized well suspected common duct wounds. Although most 41 deaths due major vascular sequelae hemorrhagic shock, did contribute significant morbidity five mortalities during earlier years review.