Triple tubostomy and its outcome for blunt duodenal injury

Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with tr...

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Autores principales:	Narendra Pandit, Tek Narayan Yadav, Laligen Awale, Shailesh Adhikary
Formato:	article
Lenguaje:	EN
Publicado:	Society of Surgeons of Nepal 2019
Materias:	Duodenal injury Duodenostomy Triple tube drainage Surgery RD1-811
Acceso en línea:	https://doaj.org/article/fbc46b06e4104e55bbaad8876cca021c
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spelling	oai:doaj.org-article:fbc46b06e4104e55bbaad8876cca021c2021-12-05T19:15:51ZTriple tubostomy and its outcome for blunt duodenal injury10.3126/jssn.v22i1.287101815-39842392-4772https://doaj.org/article/fbc46b06e4104e55bbaad8876cca021c2019-12-01T00:00:00Zhttps://www.nepjol.info/index.php/JSSN/article/view/28710https://doaj.org/toc/1815-3984https://doaj.org/toc/2392-4772 Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes. Narendra PanditTek Narayan YadavLaligen AwaleShailesh AdhikarySociety of Surgeons of NepalarticleDuodenal injuryDuodenostomyTriple tube drainageSurgeryRD1-811ENJournal of Society of Surgeons of Nepal, Vol 22, Iss 1 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Duodenal injury Duodenostomy Triple tube drainage Surgery RD1-811
spellingShingle	Duodenal injury Duodenostomy Triple tube drainage Surgery RD1-811 Narendra Pandit Tek Narayan Yadav Laligen Awale Shailesh Adhikary Triple tubostomy and its outcome for blunt duodenal injury
description	Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes.
format	article
author	Narendra Pandit Tek Narayan Yadav Laligen Awale Shailesh Adhikary
author_facet	Narendra Pandit Tek Narayan Yadav Laligen Awale Shailesh Adhikary
author_sort	Narendra Pandit
title	Triple tubostomy and its outcome for blunt duodenal injury
title_short	Triple tubostomy and its outcome for blunt duodenal injury
title_full	Triple tubostomy and its outcome for blunt duodenal injury
title_fullStr	Triple tubostomy and its outcome for blunt duodenal injury
title_full_unstemmed	Triple tubostomy and its outcome for blunt duodenal injury
title_sort	triple tubostomy and its outcome for blunt duodenal injury
publisher	Society of Surgeons of Nepal
publishDate	2019
url	https://doaj.org/article/fbc46b06e4104e55bbaad8876cca021c
work_keys_str_mv	AT narendrapandit tripletubostomyanditsoutcomeforbluntduodenalinjury AT teknarayanyadav tripletubostomyanditsoutcomeforbluntduodenalinjury AT laligenawale tripletubostomyanditsoutcomeforbluntduodenalinjury AT shaileshadhikary tripletubostomyanditsoutcomeforbluntduodenalinjury
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Triple tubostomy and its outcome for blunt duodenal injury

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