Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Department of Surgery, Westmead Children's Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Jan;91(1-2):95-99. doi: 10.1111/ans.16502. Epub 2020 Dec 28.
Traumatic duodenal injuries in children are rare, and few studies have documented duodenal injuries in children, especially in Australasia. This study assessed the mechanism, investigations, management and outcomes of children (aged <16 years) with duodenal injuries.
Retrospective review was conducted over a 16-year period from a single paediatric trauma centre.
Sixteen cases of duodenal injuries were identified: 15 cases of blunt duodenal injury and only one case of penetrating injury. Motor vehicular accidents were the most common cause of injury, followed by auto-pedestrian injuries and handlebar injuries. Only grade I and II injuries were identified. Computed tomography aided diagnosis in all cases of blunt duodenal injuries, especially given the variable nature of symptoms. Eight patients underwent laparotomy, of whom five required duodenal repair. Three patients underwent primary repair with omental patch, one patient underwent primary repair with gastrostomy and one patient underwent two-layered repair with t-tube duodenostomy. There were no delays in operative management within 24 h and no complications identified.
In comparison to other paediatric trauma centres worldwide, the majority of duodenal injuries were low grade and attributed to blunt trauma. Computed tomography aided diagnosis in all cases of blunt duodenal injury. Primary repair of duodenal injuries was possible in the majority of cases requiring operative repair.
儿童外伤性十二指肠损伤较为罕见，且鲜有研究记录儿童十二指肠损伤情况，特别是在澳大拉西亚地区。本研究评估了儿童（<16 岁）十二指肠损伤的机制、检查、治疗和结局。
对单家儿科创伤中心 16 年来的病例进行回顾性分析。
共发现 16 例十二指肠损伤：15 例为钝性十二指肠损伤，仅 1 例为穿透性损伤。机动车事故是最常见的致伤原因，其次是汽车-行人伤和车把伤。仅发现 I 级和 II 级损伤。所有钝性十二指肠损伤均通过计算机断层扫描辅助诊断，尤其是鉴于其症状的多变性。8 例行剖腹术，其中 5 例行十二指肠修复术。3 例患者行一期网膜修补术，1 例行胃造口术，1 例行双层 T 管十二指肠吻合术。所有患者均在 24 小时内及时进行手术治疗，无手术延误，也未发生并发症。
与世界上其他儿科创伤中心相比，大多数十二指肠损伤为低级别损伤，且由钝性创伤引起。计算机断层扫描辅助所有钝性十二指肠损伤的诊断。大多数需要手术治疗的十二指肠损伤可采用一期修复。
