Ntongwetape Ngwane, Weledji Elroy Patrick, Mokake Divine Martin Ngomba
Department of Surgery, Faculty of Health Sciences, University of Buea, S.W. Region, Buea, Cameroon.
Surg Case Rep. 2024 Aug 23;10(1):194. doi: 10.1186/s40792-024-01998-4.
The worldwide increase in road traffic crashes and use of firearms has increased the incidence of duodenal injuries. Upper gastrointestinal radiological studies and computed tomography (CT) in resource settings may lead to the diagnosis of blunt duodenal injury. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. Although the majority of duodenal injuries may be managed by simple repair, high-risk duodenal injuries are followed by a high incidence of suture line dehiscence and should be treated by duodenal diversion.
We report a case of a failed primary repair of a blunt injury to the second part of the duodenum (D2) in a 24-year-old African man. This was successfully managed by a tube duodenostomy, a bypass gastrojejunostomy and a feeding jejunostomy in a low resource setting.
Detailed knowledge of the available operative choices in duodenal injury and their correct application is important. When duodenal repair is needed, conservative repair techniques over complex reconstructions should be utilised. The technique of tube duodenostomy can be successfully applied to cases of large defects in the second part of the duodenum (D2), failed previous repair attempts and with defects caused by different aetiology. It may remain especially useful as a damage-control procedure in patients with multiple injuries, significant comorbidities and/or haemodynamic instability.
全球道路交通事故和枪支使用的增加导致十二指肠损伤的发生率上升。在资源有限的情况下，上消化道放射学检查和计算机断层扫描（CT）可能有助于诊断钝性十二指肠损伤。如果在影像学征象缺失或不明确的情况下仍高度怀疑十二指肠损伤，剖腹探查仍是最终的诊断性检查。虽然大多数十二指肠损伤可通过简单修复处理，但高危十二指肠损伤的缝合线裂开发生率较高，应采用十二指肠转流术治疗。
我们报告一例24岁非洲男性十二指肠第二部（D2）钝性损伤一期修复失败的病例。在资源有限的情况下，通过十二指肠造瘘管置入、胃空肠吻合旁路术和空肠造瘘术成功处理了该病例。
详细了解十二指肠损伤的可用手术选择及其正确应用非常重要。需要进行十二指肠修复时，应采用保守修复技术而非复杂的重建手术。十二指肠造瘘管置入技术可成功应用于十二指肠第二部（D2）大缺损、既往修复尝试失败以及由不同病因导致缺损的病例。作为一种损伤控制手术，它在多发伤、严重合并症和/或血流动力学不稳定的患者中可能仍然特别有用。
