Journal Article Observational Study Epublish 1 citation
PubMed: 41366408 DOI: 10.1186/s13017-025-00661-z
How are duodenal trauma managed? A French nationwide study.
World J Emerg Surg 20(1):89
Authors: Sébastien Frey, Imad Bentellis, Sébastien Gaujoux, Edouard Girard, Julio Abba, Mircea Chirica, Martin Bertrand, Etienne Boutry, Diane Mège, Mathilde Aubert, Arnaud Alves, Emmanuel Hornez, Andrea Mulliri, Raffaele Brustia, Hassen Hentati, Lelde Lauka, Alexis Laurent, Daniele Sommacale, Célia Turco, Maude Dezeustre, Melinda Bajul, Antoine Castel, Olivier Facy, Robin Grellet, Laurent Sulpice, Fabrice Ménégaux, Maxime Delestre, Emilie Lermite, Tristan Monchal, Rida Amrou, Ophélie Bacoeur-Ouzillou, Denis Pezet, Jeremy Bonnet, Emmanuel Buc, Guillaume Passot, Anne-Sophie Schneck, David Jérémie Birnbaum, Pierre-Yves Blanc, Bertrand Le Roy, Olivier Monneuse, Quentin Rodriguez, Bertrand Suc, Patrick Baqué, Vincent Dubuisson, Damien Massalou
Affiliations
- University Côte d'Azur, Nice, France.
- Department of Digestive Surgery, University Hospital of Nice, Pasteur Hospital, Nice, France.
- Department of Urology, Clinique Saint-Jean, Cagnes-Sur-Mer, France.
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
- CNRS, UMR 5525, VetAgro Sup, Grenoble INP, University Grenoble Alpes, Grenoble, France.
- Department of Digestive and Emergency Surgery, University Hospital of Grenoble Alpes, TIMC, Grenoble, France.
- Department of Digestive and Oncological Surgery, University Hospital of Nîmes, Nîmes, France.
- Department of Digestive and Oncological Surgery, Timone Hospital, University Hospital of Marseille, Marseille, France.
- Department of Digestive Surgery, University of Caen Normandie, Caen, France.
- Inserm Unity UMR 1086, ANTICIPE, Caen, France.
- Department of Visceral and Digestive Surgery, Percy Military Teaching Hospital, Clamart, France.
- UPEC - INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", University Paris Est-Créteil, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France.
- Department of Digestive and Oncologic Surgery - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France.
- Department of Hepatobiliary and Digestive Surgery, University Hospital of Rennes, Rennes, France.
- Department of Digestive and Oncological Surgery, University Hospital of Dijon, Dijon, France.
- Department of Digestive and Visceral Surgery, University Hospital of Angers, Angers, France.
- Department of Visceral, Digestive, and Oncological Surgery, Sainte-Anne Military Teaching Hospital, Toulon, France.
- Department of Digetive and Hepatobiliary Surgery, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
- Department of Digestive Surgery, University Hospital of Guadeloupe, Pointe-À-Pitre, France.
- Department of Digestive and Oncological Surgery, University Hospital of Lyon Sud, Lyon, France.
- Department of Visceral and Digestive Surgery, Hôpital Nord, University Hospital of Marseille, Marseille, France.
- Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France.
- Emergency Surgical Departement, Trauma Center, Edouard Herriot Hospital, Université Claude Bernard Lyon 1, Lyon, France.
- Department of Digestive Surgery and Organ Transplantation, University Hospital of Toulouse, Toulouse, France.
- University Côte d'Azur, Nice, France.
- Department of Digestive Surgery, University Hospital of Nice, Pasteur Hospital, Nice, France.
- Department of Digestive Surgery, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France.
- ICARE Lab, Inserm, U1091 (IBV), Nice, France.
Abstract
BACKGROUND
Duodenal injuries are rare, associated with a significant morbidity. Their management is challanging and remains controversial.
METHODS
A retrospective study of all consecutive patients with duodenal trauma managed in 21 French trauma centers from 2004 to 2023. Clinical data, trauma mechanisms, injury severity, treatment modalities and outcomes were collected. Specific attention was given to surgical techniques such as damage control laparotomy, primary repair only and duodenal diversion. Statistical analysis was performed to identify factors associated with duodenal leak, severe morbidity and mortality.
RESULTS
One hundred and thirty-five patients (71.7% male, mean age 35 years) were included, 64% with blunt trauma. Duodenal AAST grades I-II occurred in 68.2% and grades III-V in 31.8%. A discrepancy between radiologic evaluation and intraoperative observations was present in 30.8% of cases, underestimating injury severity in 29.1%. Initial management was nonoperative for 12.7%. Damage control laparotomy was required in 36.6%. Operated patients underwent direct suture (69.2%), duodenal resection (24.4%), duodenal diversion (35.8%). Duodenal leaks occurred in 23.7%, significantly increased by hemodynamic instability (OR = 3.08, p = 0.015) and associated pancreatic trauma (OR = 2.44, p = 0.044). Reoperation rate was 18.5%, for missed duodenal injury (16%) and/or for duodenal leak (32%). Mean length of stay was 27 days. Major morbidity was 27.4% and 30-day mortality 10.4%. The injury severity score was the only predictive factor of major morbidity and mortality.
CONCLUSIONS
Duodenal trauma remains a severe condition managed mostly with primary repair, where duodenal leak-significantly associated with hemodynamic instability and pancreatic injury, is a major driver of reintervention.
TRIAL REGISTRATION
This study was registered on Clinical Trials under the registration numbe NCT06058975.
MeSH
Mortality, Surgical Procedures, Operative, Morbidity, Wounds And Injuries, Laparotomy, Hemodynamics