EFFECTS OF SURGICAL PROCEDURES ON MORTALITY AND MORBIDITY IN TRAUMATIC INJURIES OF PANCREAS AND DUODENUM
CEMALETTİN ERTEKİN, KAYHAN GÜNAY, SAMAN BELGERDEN, MEHMET ÇAĞLIKÜLEKÇİ, ÖMER TÜREL
İstanbul Tıp Fakültesi, Genel Cerrahi A.B.D./İSTANBUL
From 1986 to 1991, 39 patients with duodenal (16-%41), pancreatic (17-%43.5) or combined pancreatoduodenal (6-%15.5) injuries were treated at the Surgical Emergency Unit of İstanbul Medical Faculty. In a total of 22 injuries including the combined ones, the duodenal injury was managed by duodenorraply with various decompression methods in 14 (%66) and simple repair (only duodenorraphy) in 7 (%33.3) patients. Primary repair in 16 (%69.5) and resection in 6 (%26) patients were used for the management of pancreatic trauma in 23 pancreatic and/or pancreatoduodenal injuries. Complications related to the duodenum and pancreas developed in 6 (%15.3) cases of which 3 were duodenal fistulas. The three fistulae occurred when tubes were placed through the duodenal wall. Neither duodenal nor pancreatic mortality was noted. On the other hand overall mortality rate was %15.3 (6 cases). Based on these data, the authors recommend primary repair of duodenal injuries with decompression of the suture line by a tube inserted in a remote site of the bowel (stomach and/ or jejunum), and suggest drainage for the majority of pancreatic injuries. Pancreatic resection should be reserved for injuries requiring debridement for hemostasis.