Successful treatment of victims with closed abdominal trauma with damage to the duodenum (clinical observations)

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Abstract

This article presents two clinical observations of successful treatment of victims with closed abdominal trauma complicated by duodenal injury, with an emphasis on key aspects of treatment and prevention of complications.

Injuries to internal organs in closed abdominal trauma pose a serious threat to the lives of victims, especially in cases of damage to the duodenum. Despite the fact that duodenum injuries constitute a relatively small proportion of all abdominal injuries, they are accompanied by a high mortality rate, reaching 30% in isolated injuries and up to 80% in combined injuries. Diagnosis of such injuries is a particular problem. The absence of pathognomonic symptoms, as well as the frequent combination with other injuries (e.g., pancreas, retroperitoneal hematomas, or pelvic fractures) complicates the timely detection of these injuries. In addition, inadequate surgical tactics can lead to severe postoperative complications, including duodenal fistula (2%–16%), intra-abdominal abscess (15%), and pancreatitis (0.5%). The high incidence of severe complications and significant mortality emphasizes the importance of studying effective diagnostic methods, surgical tactics, and postoperative management of patients with duodenal injury.

According to the literature, the incidence of duodenal injury in closed abdominal trauma ranges from 0.6 to 5% of all abdominal injuries. The most common injuries are to the retroperitoneal part of the intestine; the horizontal part is injured in 30%–40% of cases, the descending part in 20%–30%, and the upper part in 15%–22%. A significant problem is the recognition of retroperitoneal ruptures in combination with pancreatic injury and the presence of retroperitoneal hematomas caused by kidney injury or pelvic bone fracture. There are no pathognomonic symptoms of duodenal injury.

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About the authors

Andrey E. Demko

Kirov Military Medical Academy; Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: demko@emergency.spb.ru
ORCID iD: 0000-0002-5606-288X
SPIN-code: 3399-8762

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Vladimir G. Verbitsky

Kirov Military Medical Academy; Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: verbitsky1961@mail.ru
ORCID iD: 0000-0001-6969-7270
SPIN-code: 6981-0621

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Anton O. Parfenov

Kirov Military Medical Academy; Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: parfenov_anton@mail.ru
ORCID iD: 0000-0002-1192-4087
SPIN-code: 1620-6415

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Evgenii A. Kolchanov

Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: di@yandex.ru
ORCID iD: 0000-0001-9716-4981

MD

Russian Federation, Saint Petersburg

Aleksei V. Kosachev

Kirov Military Medical Academy; Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: avkos1@mail.ru
ORCID iD: 0009-0005-2073-6159
SPIN-code: 6137-4356

MD

Russian Federation, Saint Petersburg; Saint Petersburg

Egor V. Yurkevich

Kirov Military Medical Academy

Email: yurkeviche1997@mail.ru
ORCID iD: 0009-0006-2090-149X
SPIN-code: 3160-8808

MD

Russian Federation, Saint Petersburg

Grigory A. Mamedov

Kirov Military Medical Academy

Email: grisha1132xx1@mail.ru
ORCID iD: 0009-0000-9122-1041
SPIN-code: 3488-6107

MD

Russian Federation, Saint Petersburg

Dmitrii V. Nagornov

Kirov Military Medical Academy

Author for correspondence.
Email: diman12144@yandex.ru
ORCID iD: 0009-0001-5533-3676
SPIN-code: 8514-7959

MD

Russian Federation, 6 Akademika Lebedeva St., Saint Petersburg, 194044

References

  1. Bonomi AM, Granieri S, Gupta S, et al. Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm. Updat Surg. 2021;73(2):703–710. doi: 10.1007/s13304-020-00929-w
  2. Coccolini F, Kobayashi L, Kluger Y, et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg. 2019;14:56. doi: 10.1186/s13017-019-0278-6
  3. Mikhailov AP, Sigua BV, Danilov AM. Damage to the duodenum. Saint Petersburg: ELBI-SPb; 2010. 86 p. (In Russ.)
  4. Poyrazoglu Y, Duman K, Harlak A. Review of pancreaticoduodenal trauma with a case report. Indian J Surg. 2016;78(3):209–213. doi: 10.1007/s12262-016-1479-9
  5. Gavrishuk YV, Kulagin VI, Manukovsky VA, et al. Treatment of a victim with blunt abdominal trauma with multiple damage to the duodenum and pancreas: clinical case. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;(15)30–36. EDN: KDTNHP doi: 10.54866/27129632_2024_2_30
  6. Ordoñez CA, Parra MW, Millán M, et al. Damage control in penetrating duodenal trauma: less is better – the sequel. Colomb Med (Cali). 2021;52(2):e4104509. doi: 10.25100/cm.v52i2.4509
  7. Abdel-Aziz H, Dunham CM. Effectiveness of computed tomography scanning to detect blunt bowel and mesenteric injuries requiring surgical intervention: a systematic literature review. Am J Surg. 2019;218(1):201–210. doi: 10.1016/j.amjsurg.2018.08.018

Supplementary files

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2. Fig. 1. Intraoperative photos. The arrows indicate the defect in the duodenal wall.

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3. Fig. 2. Abdominal multislice computer tomography scan. Arrow indicates free gas in the abdomen.

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4. Fig. 3. Photo of a duodenal defect detected during video gastroscopy (the defect is indicated by the arrow).

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5. Fig. 4. Intraoperative photo. The arrow indicates free blood in the liquid part and clots.

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6. Fig. 5. Intraoperative photo. The arrow indicates a defect in the wall of the duodenum, which allows the instrument to pass freely into the intestinal lumen.

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