Fang J F, Chen R J, Lin B C, Hsu Y B, Kao J L, Kao Y C, Chen M F
Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taiwan, Republic of China.
J Trauma. 1999 Apr;46(4):652-5. doi: 10.1097/00005373-199904000-00015.
Delay in surgical treatment and duodenal wound dehiscence are two major causes of extensive retroperitoneal abscess formation after blunt duodenal injury. This complication is traditionally treated with primary repair of the duodenal wound and drainage of the abscess through anterior laparotomy. Pyloric exclusion is sometimes added as an adjunctive procedure. The anterior approach, however, may result in inadequate drainage, and repeat surgery is sometimes needed. We reviewed our experiences and evaluated the effectiveness of retroperitoneal laparostomy for the treatment of retroperitoneal abscess with continuous soiling.
There were 52 blunt duodenal injuries during a 7-year period. Eleven patients developed extensive retroperitoneal abscesses.
All 11 patients were treated with anterior laparotomy initially. Five patients recovered after this procedure. Six patients continued to have retroperitoneal abscesses and were under septic status. Two patients received another anterior drainage, and had recurrent abscesses later. Retroperitoneal laparostomy was performed for these six patients. After retroperitoneal laparostomy, daily wound care, and antibiotic treatment, all six patients recovered. Only two patients developed incisional hernia.
Retroperitoneal laparostomy is effective in treating extensive intractable retroperitoneal abscess after blunt duodenal injury. Patients with the complications of duodenal leak and extensive retroperitoneal abscess should be treated with pyloric exclusion and drainage through anterior laparotomy first. If the duodenal wound does not heal after pyloric exclusion and retroperitoneal abscess persists, retroperitoneal laparostomy should be performed without further attempt to repair the wound.
手术治疗延迟和十二指肠伤口裂开是钝性十二指肠损伤后广泛腹膜后脓肿形成的两个主要原因。传统上，这种并发症采用十二指肠伤口一期修复和经前正中剖腹术进行脓肿引流治疗。有时会加做幽门旷置术作为辅助手术。然而，前路手术可能导致引流不充分，有时需要再次手术。我们回顾了我们的经验，并评估了腹膜后剖腹造口术治疗持续污染的腹膜后脓肿的有效性。
在7年期间共有52例钝性十二指肠损伤患者。11例患者发生了广泛的腹膜后脓肿。
所有11例患者最初均接受了前正中剖腹术。5例患者术后康复。6例患者持续存在腹膜后脓肿且处于脓毒症状态。2例患者接受了另一次前路引流，后来又出现了复发性脓肿。对这6例患者实施了腹膜后剖腹造口术。经过腹膜后剖腹造口术、每日伤口护理和抗生素治疗后，所有6例患者均康复。仅2例患者发生了切口疝。
腹膜后剖腹造口术治疗钝性十二指肠损伤后广泛的顽固性腹膜后脓肿有效。十二指肠瘘和广泛腹膜后脓肿并发症患者应首先行经前正中剖腹术进行幽门旷置和引流。如果幽门旷置后十二指肠伤口未愈合且腹膜后脓肿持续存在，则应实施腹膜后剖腹造口术，而不要再尝试修复伤口。
