DUODENAL IN JURIES

Duodenal injuries, although relatively infrequent, remain an important cause of morbidity and mortality in the trauma patient. In the last 10 years, 41 cases with duodenal trauma, treated at Department of General Surgery, School of Medicine, University of Çukurova were retrospectively reviewed. The cases were classified according to the system proposed by Roman and colleagues: Complete or partial (intramural hematom or serosal injury) injury in type I and II injuries were seen at 32 (78%); associated minimal pancreatic injury with complet or partial duodenal injury as type III at 5 (12%) and severe pancreatic injury with large duodenal defects or ductal impairment as type IV were obtained at 4 (10%) of the cases. Primary suture was performed to 30 (73%) cases, segmental resection and primary anastomosis to 4 (10%) cases, duodenal diverticulization to 3 (7.3%) cases, pyloric exclusion to 2 (5%) and whipple procedure to 2 (5%) cases. Duodenal fistulae developed at 4 (10%) of the cases and sepsis developed at 3 (7.3%). In the peroperative and the early postoperative period, 4 cases died due to hipovolemic shock and 3 cases died because of anastomotic dehiscence, sepsis and multiple organ failure. In type III and type IV, all of the cases died.

DUODENUM YARALANMALARI

Retroperitoneal lokalizasyonu nedeni ile duodenum yaralanmalarý nadir görülür. Yüksek morbidite ve mortaliteye neden olur. Son 10 yýllýk dönemde duodenum yaralanmasý nedeni ile kliniðimizde tedavi edilen 41 olgu, bu çalýþmada retrospektif olarak incelenmiþtir. Olgular Roman Sýnýflamasýna göre grublara ayrýlmýþtýr: Pankreatik yaralanma bulunmayan, komplet veya parsiyel (intramural hematom veya ser-azal yaralanma) yaralanma saptanan 32 (%78) olgu tip I ve II, hafif pankreatik yaralanma bulunan 5 (%12) olgu tip III, aðýr pankreas yaralanmasý, aðýr duktal harabiyetin bulunduðu ve geniþ devitalize duodenal dokunun bulunduðu 4 (%10) olgu ise tip IV olarak belirlendi. Otuz (%73) olguya duodenorafi, 4 (%10) olguya segmental rezeksiyon+anastomoz, 3 (%7.3) olguya divertikülizasyon, 2 (%5) olguya pilorik ekiklüzyon ve 2 (%5) olguya Whipple ameliyatlarý uygulandý. Duodenal fistül 4 (%10) olguda, sepsis 3 (%7.3) olguda geliþti. Peroperatif ve erken postoperatif dönemde 4 (%10) olguda hipovolemik þok; 3 (%7.5) olguda ise geç aperatif dönemde anastomoz kaçaðý, sepsis ve multi-organ yetmezliði nedeni ile mortalite oluþtu. Tip III ve Tip IV olgularýn tümünde mortalite geliþti.