DAMAGE CONTROL AND DEFINITIVE SURGERY IN A CASE OF FATAL BLUNT TRAUMA ABDOMEN

  • Suvendu Maji Resident in Department of General Surgery, Institute of Postgraduate Medical Education & Research(I.P.G.M.E&R), Kolkata, WB
  • Makhan Lal Saha Professor, Department Of General surgery, I.P.G.M.E&R, Kolkata, WB, India
  • Kamal Singh Kanwar resident in Department of General Surgery, I.P.G.M.E. & R., Kolkata, WB, India
  • Soumen Das Assistant professor, Department Of General surgery, I.P.G.M.E&R, Kolkata, WB, India
Keywords: pancreaticoduodenal injury, pyloric exclusion, damage control surgery, superior mesenteric vein tear, hemoperitoneum

Abstract

Pancreaticoduodenal injuries are rare, life-threatening, and challenging to treat. Diagnosis is often delayed and needs a high index of suspicion. In spite of the best management outcome remains grim. The concept of Damage Control Surgery is well known and most of it comes from experiences in the battleground. It consists of treating the most serious injuries first, tackling infection, and leaving definitive surgery to a later date. We herein describe such a case where a young boy sustained serious life-threatening pancreaticoduodenal and vascular injuries, encountered by a surgeon bestowed with minimal facilities and little expertise, who aptly managed the case with damage control surgery, before referring him to us for definitive management. We conclude that damage control surgery and prompt referral to higher centers is a correct approach to the management of patients presenting at non-trauma/less equipped centers and must be practiced strongly.

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References

1. Sharma.Atul.K Management of Pancreaticoduodenal Injuries. Indian Journal of Surgery.2012;74(1):35-39.
2. Moore EE. Staged laparotomy for the hypothermia, acidosis and coagulopathy syndrome. Am J Surg.1996;172:405–410. doi: 10.1016/S0002-9610(96)00216-4. [PubMed] [Cross Ref]
3. Bailey &Love. Short practice of surgery. 25th ed. Great Britain. Hodder Arnold; 2008
4. Kochar SK. Principles and Practice of Trauma Care. 2nd ed. NewDelhi. Jaypee Brothers; 2013
5. Desai KM, Dorward IG, Minkes RK, Dillon PA. Blunt duodenal injuries in children. J Trauma 2003;54:640–5; discussion 645–6
6. Fatima J, Baron TH, Topazian MD, et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg 2007;142:448–54; discussion 454–5
7. Ivatury R, Nassoura Z, Simon R, Rodriguez A. Complex duodenal injuries. Surg Clin North Am 1996;76:797–812
8. Rickard MJ, Brohi K, Bautz PC. Pancreatic and duodenal injuries: keep it simple. Aust N Z J Surg 2005;75:581–6.
9. Seamon MJ, Pieri PG, Fisher CA, et al. A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? J Trauma 2007;4:829–33.
10. Clendenon JN, Meyers RL, Nance ML, Scaife ER. Management of duodenal injuries in children. J Pediatr Surg 2004;39:964–8.
11. Cogbill TH, Moore EE, Feliciano DV, et al. Conservative management of duodenal trauma: a multicenter perspective. J Trauma 1990;30:1469–75
12. Vaughn G, Grazier O, Graham D, et al. The use of pyloric exclusion in the management of severe duodenal injuries. Am J Surg 1977;134:785–90.
13. Martin T, Feliciano D, Mattox KL, Jordan GL Jr. Severe duodenal injuries: treatment with pyloric exclusion and gastrojejunostomy. Arch Surg 1983;118:631–5.
14. Kashuk JL, Moore EE, Cogbill TH. Management of the intermediate severity duodenal injury. Surgery 1982;92:758–64.
How to Cite
1.
Maji S, Saha ML, Kanwar KS, Das S. DAMAGE CONTROL AND DEFINITIVE SURGERY IN A CASE OF FATAL BLUNT TRAUMA ABDOMEN. Med. res. chronicles [Internet]. 2015Apr.15 [cited 2024Dec.22];2(2):217-21. Available from: https://medrech.com/index.php/medrech/article/view/74
Section
Case Report