Pediatric DI is most frequently due to blunt trauma which occurs in 70–78% of cases. Penetrating trauma is the most common cause of duodenal injury (DI) in adult patients, accounting for 53.6–90% of cases. Presence and type of associated injuries greatly impact the treatment of duodenal trauma. Associated injuries are present in 68–86.5% of patients, with major vascular injury occurring in 23–40% of cases. Pediatric duodenal trauma is also rare, occurring in < 1% of all pediatric trauma and 2–10% of children with abdominal trauma.
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Transition of treatment strategies should occur as quickly and seamlessly as possible as morbidity and mortality both increase with delays in treatment.Īdult duodenal trauma has an incidence of 0.2–0.6% of all trauma patients and 1–4.7% of all cases of abdominal trauma.
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Moreover, endoscopy, interventional radiology, and gastroenterology may be involved to improve success of non-operative management (NOM) and to manage early and late sequelae of injury and complications. The initial phase is best managed by trauma or emergency surgeons but the late reconstructive phase should involve hepatobiliary surgeons. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.ĭuodeno-pancreatic and extrahepatic biliary tree injuries are, by definition, transitional lesions that may involve one or more anatomical structures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. Late diagnosis and treatment are both associated to increased morbidity and mortality. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common.