Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury.
Ann R Coll Surg Engl
; 106(5): 413-417, 2024 May.
Article
en En
| MEDLINE
| ID: mdl-38445581
ABSTRACT
BACKGROUND:
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. TECHNIQUE 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Píloro
/
Duodeno
/
Yeyuno
Límite:
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Ann R Coll Surg Engl
Año:
2024
Tipo del documento:
Article
País de afiliación:
Irlanda
Pais de publicación:
Reino Unido