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Duodenal Injury

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A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries?
Seamon MJ, Pieri PG, Fisher CA, Gaughan J, Santora TA, Pathak AS, Bradley KM, Goldberg AJ.
J Trauma. 2007 Apr;62(4):829-33.

Rationale for inclusion:  Using a retrospective review of 29 patients with penetrating duodenal injuries, this study concluded that simple repair without pyloric exclusion is safe management for the majority of these injuries, with increased complications in patients undergoing pyloric exclusion.

Citations - 79 (as of July 2017)

Pancreatic and duodenal injuries: keep it simple.
Rickard MJ, Brohi K, Bautz PC.
ANZ J Surg. 2005 Jul;75(7):581-6.

Rationale for inclusion: This analysis supports the use of simplified treatment algorithms for pancreatic and duodenal trauma utilizing a staged approach, using analysis of 100 consecutive patients. 

Citations - 98 (as of July 2017)

Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries.
Asensio JA, Petrone P, Roldán G, Kuncir E, Demetriades D.
J Am Coll Surg. 2003 Dec;197(6):937-42.

Rationale for inclusion: This review evaluated a 10 year experience of complex pancreatoduodenal  injuries requiring Whipple procedure and concluded while uncommon, these are all AAST grade V pancreatic and duodenal injuries with overall survival of only 67%.

Citations - 134 (as of July 2017)

Prognostic factors and management of civilian penetrating duodenal trauma.
Timaran CH, Martinez O, Ospina JA.
J Trauma. 1999 Aug;47(2):330-5.

Rationale for inclusion: A single center retrospective review, this study identified shock and additional abdominal injuries to the pancreas, mesenteric vessels, and colon are associated with increased complications following penetrating duodenal trauma.

Citations - 69 (as of July 2017)

Conservative management of duodenal trauma: a multicenter perspective.
Cogbill TH, Moore EE, Feliciano DV, Hoyt DB, Jurkovich GJ, Morris JA, Mucha P Jr, Ross SE, Strutt PJ, Moore FA, et al.
J Trauma. 1990 Dec;30(12):1469-75.

Rationale for inclusion: This multi-institutional analysis of 164 duodenal injuries supported the use of primary repair for most injuries and concluded that while pyloric exclusion techniques are useful for complex injuries, pancreaticoduodenectomy is rarely necessary and tube duodenostomy is not required, supporting the trend toward simplified management of the duodenal injury.

Citations - 276 (as of July 2017)

Management of duodenal wounds.
Stone HH, Fabian TC.
J Trauma. 1979 May;19(5):334-9.

Rationale for inclusion: This review evaluated 321 injuries of the duodenum dating back to 1962, characterizing significant morbidity in these patients, with no survival in patients in whom pancreatoduodenectomyl  was attempted.

Citations - 174 (as of July 2017)

The use of pyloric exclusion in the management of severe duodenal injuries.
Vaughan GD 3rd, Frazier OH, Graham DY, Mattox KL, Petmecky FF, Jordan GL Jr.
Am J Surg. 1977 Dec;134(6):785-90.

Rationale for inclusion: This series of 75 patients in the 1970s with duodenal injuries demonstrated the utility of temporary pyloric exclusion and gastrojejunostomy to combat the mortality and morbidity associated with this injury.

Citations - 205 (as of July 2017)

Duodenal "diverticulization" for duodenal and pancreatic injury.
Berne CJ, Donovan AJ, White EJ, Yellin AE.
Am J Surg. 1974 May;127(5):503-7.

Rationale for inclusion: Published in 1974, this represents an initial case series of 34 patients with severe pancreatic and duodenal injuries treated with duodenal diverticulization with antrectomy, gastrojejunostomy, tube duodenostomy, closure of the injury and drainage with high rates of complication.

Citations - 254 (as of July 2017)

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