OUR EXPERIENCE OF SURGICAL TREATMENT OF VICTIMS WITH FRAGMENTARY GUNSHOT WOUNDS OF THE DUODENUM

Abstract

Summary. Introduction. One of the most serious gunshot wounds among the organs of the abdominal cavity is damage to the duodenum. Aim. The improvement of the results of surgical treatment of victims with severe abdominal trauma – shrapnel penetrating wounds of the abdominal cavity with damage to the duodenum. Materials and methods. The results of treatment of 12 patients with mine-explosive injury, shrapnel penetrating wounds of the abdominal cavity with duodenal damage were analyzed. Among the victims were only men (100 %), aged 22 to 59 years. Results. Patients were delivered within 4 to 18 hours of injury. In the structure of injuries, only 2 (17 %) patients had isolated damage to the duodenum, the other 10 (83 %) had combined and multiple injuries. All 10 patients had shrapnel wounds and penetrating injuries of the limbs, of which 7 had a traumatic hemopneumothorax, 6 had damage to the kidney and retroperitoneal space, 3 had damage to the pancreas and retroperitoneal space, 2 had damage to the spleen, and 2 had injuries of the inferior vena cava, in 1 – damage to the liver and wall of the ileum, in 1 – violation of the integrity of the pelvic bones. In all cases, a laparotomy was performed, after achieving temporary hemostasis, the duodenum was mobilized according to Kocher-Clermont. We consider it expedient to mobilize the duodenum according to Kocher-Clermont in the presence of the Winiwarter-Laffite triad in order to exclude a through wound of its posterior wall. As for further surgical tactics, after excision of non-viable tissues, a decision was made to completely exclude the duodenum from the process of digestion by performing the Donovan-Hagen operation, the intervention was complemented by decompression of the biliary tract. In the postoperative period, multiple organ failure syndrome developed in 3 patients, severe postoperative pancreatitis in 2, small intestinal fistula in 1, phlegmon of the retroperitoneal space in 1, bleeding (inferior vena cava damage) in 1. 3 patients died (25 %). Conclusions. We believe that it is expedient to exclude the duodenum from the digestive process in case of its shrapnel wounds (if possible).