| [ Summary ] |
Duodenal injury is a specific bowel injury in terms of diagnosis and treatment mainly because of its location in the retroperitoneal space, although the rate of occurence is relatively low. The causes are roughly devided into three, i.e, (1) blunt trauma, (2) penetrating trauma, (3) others (perforation from inside the lumen by endoscope or other foreign bodies). The two classifications of duodenal injury are presented. Accurate diagnosis is often difficult which is mainly due to location, which indicates the necessity of the CT scans and an upper gastrointestinal series, using water soluble contrast materials as well as the repeated scouting X rays. For treatment several factors should be considered, i.e, the severity of injury, time of confirmed diagnosis after injury, general condition and the coexistence of other organ injuries. Although intensive general care should be given immediately when the general condition is poor, the following principles are basically used: conservative therapy for non-perforating or non-penetrating conditions (except large intramural hematoma) and operative therapy for perforations. Appropriate selection of several kinds of operative procedures is essential, based on the degree and location of the injury. The most typical and useful procedures are exemplified, including the duodenal patch, duodenal diverticulization, pancreatico-duodenectomy, etc. |