Injuries to the duodenum – prognosis correlates with body Injury Severity Score: A prospective study

BackgroundDuodenal injury is an important hollow viscus injury in the abdomen. The study analysed the factors related to the outcome of duodenal injuries presenting to the unit.Patients and methodsProspectively collected data on a case series involving 23 patients over three years. It involved demographic details, Injury Severity Score, Revised Trauma Score, part of duodenum injured, duodenal injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. Patients with non-perforating injury were excluded.ResultsM:F ratio was 9:2. Median age was 33 years. All were operated by a senior registrar or senior. Seven out of 23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Duodenal injury severity was graded according to American Association for Surgery of Trauma-Organ Injury Scale (AAST-OIS). Seventeen/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18 h. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs were required for 3/23 patients. Five patients died. Duodenum-related mortality was zero. The mortality was related to body Injury Severity Score >45. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Adverse prognostic factors towards morbidity was injury-operation lag >18 h.