Authors :
Edla Vamshi Krishna; Usha Topalkatti; Vipin Narayan Sharma
Volume/Issue :
Volume 10 - 2025, Issue 5 - May
Google Scholar :
https://tinyurl.com/4jz4vtw5
DOI :
https://doi.org/10.38124/ijisrt/25may1787
Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.
Abstract :
Duodenal injuries are rare, comprising approximately 3–5% of abdominal traumas, and are often accompanied
by other organ injuries due to the duodenum's retroperitoneal location. Their diagnosis can be challenging, frequently
resulting in delays that increase morbidity and mortality. A significant complication is anastomotic leakage post-repair,
primarily due to the duodenum's exposure to substantial volumes of gastric, biliary, and pancreatic secretions. These factors
necessitate prompt recognition and appropriate surgical intervention to improve patient outcomes [1]. Berne’s duodenal
diverticulization, introduced in 1968, is a surgical technique designed to manage complex duodenal and pancreatic injuries.
It involves closure of the duodenal injury, gastric antrectomy with end-to-side Bill Roth II gastrojejunostomy, tube
duodenostomy, and abdominal drainage to divert gastrointestinal contents and protect the repair site [2], Pyloric exclusion
[3], reverse tube duodenostomies [4] as a protection for primary repair. In this case report, we present an isolated traumatic
duodenal injury managed with primary repair, triple tube decompression, and an innovative omental patch technique. This
approach effectively protected the duodenal suture line and facilitated healing. Similar strategies have been employed in
paediatric cases, such as a 10-year-old boy with a complete duodenal transection, who underwent primary closure with
omental reinforcement and triple tube decompression, resulting in an uneventful recovery.
References :
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- Berne CJ, Donovan AJ, White EJ, Yellin AE. Duodenal "diverticulization" for duodenal and pancreatic injury. Am J Surg. 1974 May;127(5):503-7. doi: 10.1016/0002-9610(74)90305-5.
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- Carrillo EH, Richardson JD, Miller FB. Evolution in the management of duodenal injuries. J Trauma. 1996 Jun;40(6):1037-45; discussion 1045-6. doi: 10.1097/00005373-199606000-00035.
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- Siboni S, Benjamin E, Haltmeier T, Inaba K, Demetriades D. Isolated Blunt Duodenal Trauma: Simple Repair, Low Mortality. Am Surg. 2015 Oct;81(10):961-4.
- Moore E, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Pachter HL, Shackford SR, Trafton PG. Organ injury scaling II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427Y1429
- Vaughan GD 3rd, Frazier OH, Graham DY, Mattox KL, Petmecky FF, Jordan GL Jr. The use of pyloric exclusion in the management of severe duodenal injuries. Am J Surg. 1977 Dec;134(6):785-90. doi: 10.1016/0002-9610(77)90325-7.
- Nasr EN, Bhatti MA, Warner E. Management of isolated blunt duodenal injury. J Natl Med Assoc. 1981 Jun;73(6):525-9.
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- Bittner R, Roscher R. Magen-, Duodenal- und Pankreasverletzungen: Diagnostik, operatives Vorgehen [Stomach, duodenal and pancreatic injuries: diagnosis, surgical procedure]. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990:617-23. German.
- Rehn J, Müller-Färber J. Spezielle Diagnostik und Therapie bei Verletzungen parenchymatöser Organe [Special diagnosis and treatment in injuries of parenchymatous organs (author's transl)]. Zentralbl Chir. 1979;104(12):764-9. German. PMID: 525076.
- Haertel M, Fuchs WA. Computertomographie nach stumpfem Abdominaltrauma [Computer tomography following blunt abdominal trauma (author's transl)]. Rofo. 1979 Nov;131(5):487-92. German. doi: 10.1055/s-0029-1231477.
Duodenal injuries are rare, comprising approximately 3–5% of abdominal traumas, and are often accompanied
by other organ injuries due to the duodenum's retroperitoneal location. Their diagnosis can be challenging, frequently
resulting in delays that increase morbidity and mortality. A significant complication is anastomotic leakage post-repair,
primarily due to the duodenum's exposure to substantial volumes of gastric, biliary, and pancreatic secretions. These factors
necessitate prompt recognition and appropriate surgical intervention to improve patient outcomes [1]. Berne’s duodenal
diverticulization, introduced in 1968, is a surgical technique designed to manage complex duodenal and pancreatic injuries.
It involves closure of the duodenal injury, gastric antrectomy with end-to-side Bill Roth II gastrojejunostomy, tube
duodenostomy, and abdominal drainage to divert gastrointestinal contents and protect the repair site [2], Pyloric exclusion
[3], reverse tube duodenostomies [4] as a protection for primary repair. In this case report, we present an isolated traumatic
duodenal injury managed with primary repair, triple tube decompression, and an innovative omental patch technique. This
approach effectively protected the duodenal suture line and facilitated healing. Similar strategies have been employed in
paediatric cases, such as a 10-year-old boy with a complete duodenal transection, who underwent primary closure with
omental reinforcement and triple tube decompression, resulting in an uneventful recovery.