TREATMENT OF DUODENAL INJURIES AND COMPLICATIONS AFTER SURGERY (CASE REPORTS).

A 28-year-old male patient came to Surgical Department 15.07.2003 after a gunshot wound. An emergency operation was performed. Among the other damages of different part of intestinum damage of the anterior wall of the second anatomical part of the duodenum was diagnosed intraoperatively. The size of the damaged area was 3×1 sm. The doudenal wound was sutured with two layers after updating the edges. On the fifth postoperative day the wound leakage was detected. Later the giant sizes of duodenal fistula was formed. It opened on the anterior wall of the abdomen. After patients proper preparation there was performed the operation after 6 months of initial operation. Operative access was laparotomy from right pararectal incision. The mobilization of the edges of this fistula was performed without entering the abdominal cavity. The first loop of the jejunum was constructed in Roux-an-Y form. There was formed subcutaneous canal and distal part of Roux-an-Y type constructed jejunum was passed through it. There was performed mobilization of the edges of anterior part of aponeurosis of the rectus muscle sheath nearby of the fistula. End-to-End anastomosis was performed between fistula and Roux-an-Y type constructed jejunum. Postoperative period passed without complications. A 45-year-old male patient came to Surgical Department 26.11.1992 after a car accident. After different types of investigations was diagnosed damage of the retroperitoneal wall of the third part of the duodenum. The size of the wound was 2×1 sm. An urgent operation was performed. After Cocher's maneuver a wound was found and sutured. On the postoperative day 4 passage of the duodenal content through the drainage was detected. Retroperitoneal phlegmon with severe intoxication was diagnosed. In reoperation duodenotomy was performed proximally to the damaged area. Duodenum was ligated distally from papilla Vateri. There was performed anastomosis proximally from the ligature between already formed duodenotomy area and distal part of jejunum constructed in Roux-an-Y form. The patient's condition improved the second day after surgery. Thus, according to our experience, there are no standard solutions of treatment of duodenal injuries and postoperative complications. In both cases we adopted non-standard decisions. In accordance with the received good results, we may recommend described operations as the acceptable treatment methods in specific cases.