Abstract

From 1986 to 1991, 39 patients with duodenal (16-%41), pancreatic (17-%43.5) or combined pancreatoduodenal (6-%15.5) injuries were treated at the Surgical Emergency Unit of İstanbul Medical Faculty. In a total of 22 injuries including the combined ones, the duodenal injury was managed by duodenorraply with various decompression methods in 14 (%66) and simple repair (only duodenorraphy) in 7 (%33.3) patients. Primary repair in 16 (%69.5) and resection in 6 (%26) patients were used for the management of pancreatic trauma in 23 pancreatic and/or pancreatoduodenal injuries. Complications related to the duodenum and pancreas developed in 6 (%15.3) cases of which 3 were duodenal fistulas. The three fistulae occurred when tubes were placed through the duodenal wall. Neither duodenal nor pancreatic mortality was noted. On the other hand overall mortality rate was %15.3 (6 cases). Based on these data, the authors recommend primary repair of duodenal injuries with decompression of the suture line by a tube inserted in a remote site of the bowel (stomach and/ or jejunum), and suggest drainage for the majority of pancreatic injuries. Pancreatic resection should be reserved for injuries requiring debridement for hemostasis.