Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Afr J Paediatr Surg. 2022 Oct-Dec;19(4):217-222. doi: 10.4103/ajps.ajps_74_21.
Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure.
To explore the advantages of using T-tube in surgeries for DP in children.
A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected. Patients, with closure over a T-tube to ensure tension-free healing, were critically analysed.
A total of nine DP patients with ages ranging from 2 years to 9 years were managed. Five (55.6%) patients had blunt abdominal trauma; a 2-year-old male had perforation following accidental ingestion of lollypop-stick while a 3-year-old male had DP during endoscopic evaluation (iatrogenic) of bleeding duodenal ulcers; cause could not be found in other 2 (22.2%) patients. Of the five patients with blunt abdominal trauma, 4 (80%) had large perforation with oedematous bowel, necessitating repair over T-tube. Both patients with unknown causes had uneventful outcomes following primary repair with Graham's patch. Patients with lollypop-stick ingestion and iatrogenic perforation did well with repair over T-tube. The only trauma patient with primary repair leaked but subsequently had successful repair over a T-tube. One patient with complete transection of the third part of the duodenum and pancreatic injury who had repair over T-tube died due to secondary haemorrhage on the 10 post-operative day.
Closure over a T-tube in DP, presenting late with oedematous bowel, ensures low pressure at the perforation site, forms a controlled fistula and promotes healing, thereby lessening post-operative complications.
儿童十二指肠穿孔（DP）的诊断常常被延误，这会使临床状况恶化，并使简单的闭合复杂化。
探讨在儿童 DP 手术中使用 T 管的优势。
对 2016 年 1 月至 2020 年 12 月在一家三级中心小儿外科治疗的所有 DP 患者进行了回顾性研究。收集了临床、手术和术后数据。对接受 T 管闭合以确保无张力愈合的患者进行了重点分析。
共收治 9 例 DP 患者，年龄 2 至 9 岁。5 例（55.6%）患者有钝性腹部创伤；1 例 2 岁男性因意外吞食棒棒糖棒而穿孔，1 例 3 岁男性因内镜下治疗（医源性）出血性十二指肠溃疡而穿孔；另外 2 例（22.2%）患者病因不明。在 5 例钝性腹部创伤患者中，4 例（80%）有大穿孔和水肿肠，需要 T 管修复。2 例病因不明的患者均行 Graham 补丁原发性修复后无并发症。棒棒糖棒吞食和医源性穿孔的患者在 T 管修复后恢复良好。唯一行原发性修复的创伤患者出现漏液，但随后 T 管修复成功。1 例第三部分十二指肠完全横断伴胰腺损伤的患者，T 管修复后因术后第 10 天继发性出血而死亡。
DP 伴水肿肠就诊时间晚时，T 管闭合可确保穿孔部位低压，形成可控性瘘管并促进愈合，从而减少术后并发症。
