This journal is
indexed in Scopus
Year 2020 Vol. 28 No 6
GENERAL & SPECIAL SURGERY
V.V. BOYKO 1, 2, I.A. KRYVORUCHKO 1, R.S. RIABTSEV 2, YE.G. DOTSENKO 2, Ð.Ì. SMACHYLO 1, 2, N.N. HONCHAROVA 1
SURGICAL TREATMENT OF ISOLATED AND MULTIPLE DUODENAL INJURIES
Kharkiv National Medical University MH of Ukraine 1,
Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine 2, Kharkiv
Objective. To evaluate the results of surgical treatment of patients operated on for isolated and multiple and duodenal injuries.
Methods. A retrospective two-center study was conducted in patients (n=60) with isolated and multiple duodenal injuries ≥ II degree according to the criteria of the American Association for the Surgery of Trauma (AAST) who underwent to operations in 2006-2018.
Results. 16 (26.7%) patients were with the closed injuries, 44 (73.3%) – with the penetrating injuries, 35 (79.5%) – with stab wounds, 5 (11.4%) – with gunshot traumas, 4 (9.1%) – with mine-explosive damages. Men composed 70%, women – 30%, the average age was 36 [18-73] years. On admission the RTS, ISS, and APACHE II scores were 6 [4-8], 14 [4-25], and 14 [8-32], respectively; 22 victims (36.7%) were in shock. Duodenum damage of the II degree was in 31 (51.7%) victims, III – in 24 (40%), IV – in 3 (5%) and V – in 2 (3.3%). Multiple intra-abdominal injuries occurred in 52 (86.7%) patients (1.81 associated injuries per patient). The primary suture was the most accepted surgical procedure in the majority of patients (76.4%); the duodenum was removed from the passage in 13.3%, duodenojejunostomy was performed in 6.7%, and pancreatoduodenal resection – in 3.3%. Postoperative mortality was 18.3%.
Conclusion. Duodenal injuries with early diagnosis and timely surgical intervention can be effectively treated using simple surgical methods (primary suture). Complex injuries of the duodenum and those associated with the damage to neighboring organs and structures require a more thoughtful strategy, which includes careful consideration of the physiological stability of a patient, severity of injuries, severity of changes in the abdominal cavity, retroperitoneal space, and also the experience of a surgeon.
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Kharkiv, Nauka Av., 4,
Kharkiv National Medical University,
the Surgery Department No2,
Kryvoruchko Igor A.
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Head of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.
Riabtsev Roman S., the Post-Graduate Student, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
Dotsenko Yevhen G., PhD, Deputy Chief Physician, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Kharkiv, Ukraine.
Smachylo Rostyslav M., MD, Head of the Department of the Liver and Bile Ducts Surgery, Zaytsev Institute of General and Emergency Surgery NAMS of Ukraine, Professor of the Surgery Department No1, Kharkiv National Medical University, Kharkiv, Ukraine.
Honcharova Natalya N., MD, Professor of the Surgery Department No2, Kharkiv National Medical University, Kharkiv, Ukraine.