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Damage control in penetrating duodenal trauma: less is better - the sequel. 2021
Carlos A Ordoñez, and
Michael W Parra, and
Mauricio Millán, and
Yaset Caicedo, and
Natalia Padilla, and
Alberto García, and
María Josefa Franco, and
Gonzalo Aristizábal, and
Luis Eduardo Toro, and
Luis Fernando Pino, and
Adolfo González-Hadad, and
Mario Alain Herrera, and
José Julián Serna, and
Fernando Rodríguez-Holguín, and
Alexander Salcedo, and
Claudia Orlas, and
Mónica Guzmán-Rodríguez, and
Fabian Hernández, and
Ricardo Ferrada, and
Rao Ivatury
Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
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