DUODENUM INJURIES DECOMPRESSIVE SURGERY FARES BETTER PROGNOSIS

Abstract

Twenty eight patients with duodenal injury were treated between January 1982 and December 1992. These cases constituted 2.9% of all abdominal trauma cases treated at our center. Doudenal injuries were classified according to a "trauma severity score". Serosal avulsions at the duodenum were classified as Grade I injuries, while whole duodenal wall ruptures were evaluated as Grade II. Grade III cases included concomitant organ trauma besides any injury at the duodenum. The overall mortality was 40%. The most common cause of death was haemorhagic shock (63.6%). Primary closure was performed in Grade I patients and the results were favorable. All other patients were treated surgically with or without decompressive procedures. Mortality rates in patients with and without decompression were 0% and 80% respectively, when deaths due to the haemodynamic status in the first 48 hours were excluded. We conclude that surgical treatment with duodenal decompression and Total Paranteral Nutrition (TPN) decrease mortality in patients with duodenum injuries.