TACTICS OF SURGICAL TREATMENT FOR ISOLATED DUODENAL INJURY

Abstract

Currently the diagnosis and surgical treatment of isolated duodenal injury is one of the most rare and, consequently, a complicated and completely unsolved problem in emergency surgery. In order to analyze the results of surgical treatment and to justify the optimal amount of intervention in the patients with isolated duodenal injury we have performed a study, wherein the cases of an open injury of the cut−stab character, the effects of a blow on the anterior abdominal wall have been considered. The admission time of patients generally made 6 hours. Examination radiography of abdominal organs with DeBakey − Henelt test, phagogastroduodenoscopy was performed. In cases of unexplained clinical picture the diagnostic video laparoscopy was urgently used. The factors, affecting an outcome of treating the isolated duodenal injury were as follows: the time of hospitalization of patients, size and localization of the bowel defect, timely diagnosis and choice of the surgery volume as well as the post−surgery complications. A thorough revision of a retroperitoneal space, being the one of the symptoms of the Winiwarter−Laffite triad, was accomplished. In injuries of the first and second degree, duration of an injury of no longer than 6 hours, it is necessary to close the defect of the duodenum by two−row sutures with a nasogastroduodenal intubation. At admission of the patients at later terms or with the injuries of the third degree it is expedient to exclude a passage of food on a gut by imposing a gastroenteroanastomosis with Brownian complicity and a decompression of bilious ways. On the basis of our findings the diagnostic and surgical algorithms, depending on admission time of patients to a hospital, size and localization of duodenum wall defect were designed. Key words: duodenal injury, tactics of surgical treatment, results of surgical treatment.