Pancreas sparing duodenectomy for duodenal trauma
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AC U T E C A R E S U R G E RY
Pancreas Sparing Duodenectomy for Duodenal Trauma Hanish Kataria, Robin Kaushik, Simrandeep Singh, Rajeev Sharma
Abstract Background: Although blunt abdominal trauma is frequently encountered, isolated duodenal injury is relatively
uncommon. The management of such patients is challenging and various surgical procedures are described for their management. Methods: Two patients presented to our emergency department with isolated duodenal injuries (transection and devascularisation) secondary to blunt abdominal trauma. Results: Both patients underwent exploratory laparotomy, revealing transection of the duodenum along with proximal
devascularization and detachment of mesentery at duodeno-jejunal junction without any other intra-abdominal injury (especially pancreas, colon, vena cava) for which pancreas-sparing duodenectomy (infra-ampullary) was performed. Conclusion: Pancreas-sparing duodenectomy is a valuable tool in the management of duodenal trauma, allowing
the surgeon (and the patient) to avoid the complications of major surgical resections. Key words: Duodenal injuries; abdominal trauma; infraampullary; anastomosis
Introduction Blunt abdominal trauma is usually associated with injury to the intestine in about 15 % of patients, making it the third most commonly injured organ after the liver and spleen. It is the small bowel that is injured far more frequently than the colon, possibly because of a protective effect of the relative fixity and retroperitoneal location of the colon, and such injuries usually occur due to compressive (direct) or deceleration forces that cause damage by crushing, bursting (increasing intra-luminal pressures), deforming organs, stretching or shearing that leads to tearing of mesenteric attachments, mesentery, or mesenteric vessels. This occurs more commonly at the ‘transition points’ between the fixed and mobile parts of the mesentery and intestine, more often than not, presenting as varying grades of injury in the duodeno-jejunal area or the terminal ileum [1]. Hanish Kataria MS Assistant Professor, Department of Surgery Robin Kaushik MS, DNB Professor, Department of Surgery Simrandeep Singh MS Assistant Professor, Department of Surgery Rajeev Sharma MS Professor, Department of Surgery Government Medical College & Hospital, Chandigarh, India Corresponding author: Dr Hanish Kataria MBBS, MS Department of Surgery, Government Medical College & Hospital Sector 32, Chandigarh, India, 160030 Tel.: +919646880015, e-mail: [email protected] Received 27 Feb 2017; Accepted 4 July 2017
Hellenic Journal of Surgery 89
The duodenum is uncommonly injured in blunt abdominal trauma, quite possibly due to the same factors that afford protection to the colon – duodenal injury has been reported in only about 3 - 5 % of cases after abdominal trauma, and is usually accompanied by injury to other abdominal organs because of its close anatomic relationship to structures such as the pancreas, great vessels, liver and gall bladder [2]. Such injuries are notoriously di
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