DUODENAL YARALANMALARDA TEDAVÝ

Künt ya da penetran abdominal yaralanmalarda duodenum nadir olarak etkilenen bir organdýr. Organýn retroperitoneal yerleþim ve pankreasla yakýn anatomik iliþkisi özellikle künt travmalarda birlikte yaralanma potansiyelini arttýrýr. Ocak 1993-Aralýk 1996 arasýnda duodenum yaralanmasý olan 8 olgunun yaralanma tipleri, yaralanma dereceleri, Travma Þiddet Skorlarý, Ortalama Penetran Abdominal Travma indeksleri retrospektif olarak araþtýrýldý. Grade II ve III yaralanmasý olan 4 hastaya primer onarým, Grade IV ve V yaralanmasý olan 3 hastaya Whipple ameliyatý uygulandý. Grade II'deki bir hastaya da primer onarým+tüp duodenostomi uygulandý. Tüm hastalar için yaralanmadan ameliyata kadar geçen süre 8.3 saat, ortalama kan transfüzyonu 6 ünite ve hastanede kalma süresi 27.5 gündü. Hastalarýn 2'sinde intraabdominal abse, birinde pankreatit, birinde duodenum fistülü geliþti. Bir hasta kaybedildi (% 12.5). Çalýþmamýzda duodenum izole basit yaralanmalarýnda primer onarýmýn; pankreasla birlikte olan komplike yaralanmalarda pankreatoduodenektominin güvenilir cerrahi yöntem olduðu sonucuna varýldý.

TREATMENT OF DUODENAL INJURIES

Duodenum was seldom influenced in blunt or penetrating abdominal injuries. Retroperitoneal localization of duodenum and its anatomical relation with the pancreas are factors that increase potential of injury in blunt abdominal traumas particularly. Between January 1993-December 1996 eight patients with duodenal injury were analysed in terms of tip of injury, grade of injury, Injury Severity Score, The mean Penetrating Abdominal Trauma Index. Four patients with Grade II or III injury underwent primary repair after debridement of the duodenal wound, pancreatoduodenectomy was performed in three patients with Grade IV or V injury and primary repair + tube duodenostomy in one patient with Grade II injury. The mean duration from trauma to surgery was 8.3 hours, mean transfusion requirements were 6 units of blood and mean hospital stay was 27.5 days. The complications developed after surgery were abdominal sepsis in two patients, severe pancreatitis in one patient, duodenal fistula in one patient. The overall mortality rate for the study was 12.5 per cent. We concluded that primary repair is sufficient treatment in simple isolated duodenal injuries. However in cases complicated with excessive peripancreatic homorrhage Whipple procedure should be preferred.