University Hospital Waterford, Ireland.
University of Pennsylvania, USA.
Ann R Coll Surg Engl. 2024 May;106(5):413-417. doi: 10.1308/rcsann.2023.0074. Epub 2024 Mar 6.
Duodenal injuries are relatively rare but remain a management challenge with a high incidence of postoperative complications. Guidelines from the World Society of Emergency Surgery and American Association for the Surgery of Trauma favour a primary repair for less-complex injuries, but the management of more complex duodenal trauma remains controversial with varying techniques supported, including pyloric exclusion, omental or jejunal patch closure, gastrojejunostomy and pancreatoduodenectomy. We describe the techniques used in one case of complex duodenal trauma.
The duodenum is approached via a standard laparotomy with Kocherisation. Primary repair of the duodenal perforations is performed using a 3/0 polydioxanone suture (PDS), followed by mobilisation of a loop of mid-jejunum against the area of duodenal trauma over the primary repair as a jejunal serosal patch. The antimesenteric jejunal serosal border is sutured to the serosa of the duodenum (serosa only) using a 3/0 PDS. Pyloric exclusion is then performed through an anterior gastrostomy, to control the volume of gastric juice entering the duodenum. The pylorus is sutured closed using an absorbable suture followed by closure of the anterior gastrostomy using a GIA stapling device.
十二指肠损伤相对较少见，但仍是一个具有高术后并发症发生率的治疗挑战。世界急诊外科学会和美国创伤外科学会的指南倾向于对较简单的损伤进行一期修复，但更复杂的十二指肠创伤的处理仍存在争议，支持使用各种技术，包括幽门旷置术、网膜或空肠补丁闭合术、胃空肠吻合术和胰十二指肠切除术。我们描述了一例复杂十二指肠创伤的处理技术。
通过标准剖腹术和 Kocher 化来接近十二指肠。使用 3/0 聚二氧杂环己酮缝线（PDS）对十二指肠穿孔进行一期修复，然后将一段空肠袢向十二指肠创伤区域移动，作为空肠浆膜补丁。空肠浆膜的对系膜缘用 3/0 PDS 缝合到十二指肠浆膜（仅浆膜）。然后通过前胃造口术进行幽门旷置术，以控制进入十二指肠的胃液量。使用可吸收缝线缝合关闭幽门，然后使用 GIA 吻合器关闭前胃造口术。
