Aspects of diagnosis and treatment of duodenal injuries in road accidents

Abstract

Introduction. Injuries in road accidents present a major problem with a significant impact on human health. Annually, 1.3 million people die, and up to 50 million are traumatized, with serious health consequences. In the context of these accidents, duodenal injuries represent a challenge in promptly identifying internal injuries and providing the necessary treatment. Aim of study. Identifying the causes of late detection of duodenal lesions in traffic accidents. Methods and materials. The research included a retrospective study of 34 patients with duodenal injuries following road accidents, hospitalized in the IMU. The B/F ratio 79.41% (27)/ 20.58% (7), aged 18-80. Trauma-hospitalization time: <1h-13 (38.23%), <6h-11 (32.35%), <12h-5 (14.70%), <24h–1 (2.94%), 24h –48 h 1 (2.94%), >48h-3 (8.82%), with stable hemodynamics-16 (47.05%) and unstable-18 (52.94%). As diagnostic instrumental methods were: abdominal x-ray-5 (14.7%), chest x-ray-13 (38.23%), skull x-ray-8 (23.52%), pelvis x-ray-8 (23.52%), USG-18 (52.94%), CT15 (44.11%), laparocentesis-2 (5.88%), laparoscopy-8 (23.52%). Results. Post-investigations signs of duodenal injury were: retroperitoneal hematoma-2 (5.88%), diffuse peritonitis-1 (2.94%), definite duodenal injury-1 (2.94%). Intraoperatively, the following were found: hemoperitoneum-30(88.23%), retroperitoneal hematoma-26 (76.47%), retroperitoneal phlegmon-3 (8.82%), diffuse peritonitis-6 (17.64%), imbibition retroperitoneal bile-4 (11.76%). Surgical treatment was performed according to the degree of duodenal damage. In the first degree: duodenorrhaphy–12 (35.29%), evacuation of retroperitoneal hematoma–1 (2.94%). In the II degree: duodenoraphys–5 (14.07%), antrumresection with a GEA–1 (2.94%). In degree III: duodenoraphs–5 (14.07%), with a GEA according to Braun – 2 (5.88%), In degree IV: duodenoraphs–2 (5.88%) with the exclusion of the duodenum from the passage and GEA. In grade V: exclusion of the duodenum with GEA with EEA -1 (2.94%). Postoperative complications were manifested by wound suppuration–2, suture dehiscence–4, duodenal fistula–4, retroperitoneal phlegmon–1, intraperitoneal abscesses–5, evolving peritonitis–8, sepsis–2. Relaparotomy as a result of the complications occurred in 13 patients, the lethality constituting 16 cases. Conclusion. Duodenal lesions represent a challenge in diagnosis, having non-specific symptoms and lack of obvious signs. The study emphasizes the severity of these injuries in abdominal trauma, with a great influence on lethality. Early identification and appropriate surgical intervention are essential to improve the prognosis of patients with duodenal injuries caused by road traffic accidents. human health. Annually, 1.3 million people die, and up to 50 million ar e traumatized, with serious health consequences. In the context of these accidents, duodenal injuries represent a challenge in promptly identifying internal injuries and providing the necess ary treatment. Aim of study. Identifying the causes of late detection of duodenal lesion s in traffic accidents. Methods and materials. The research included a retrospective study of 34 patients wit h duodenal injuries following road accidents, hospitalized in the IMU. The B/F ratio 79.41% (27)/ 20.58% (7), aged 18-80. Trauma-hospitalization time: <1h-13 (38.23%), <6h-11 (32.35 %), <12h-5 (14.70%), <24h–1 (2.94%), 24h –48 h 1 (2.94%), >48h-3 (8.82%), with stable hemodynami cs-16 (47.05%) and unstable-18 (52.94%). As diagnostic instrumental methods we re: abdominal x-ray-5 (14.7%), chest x-ray-13 (38.23%), skull x-ray-8 (23.52%), pelvis x-ray-8 (23. 52%), USG-18 (52.94%), CT15 (44.11%), laparocentesis-2 (5.88%), laparoscopy-8 (23.52%). Results. Post-investigations signs of duodenal injury were: retroperi toneal hematoma-2 (5.88%), diffuse peritonitis-1 (2.94%), definite duodenal injury-1 (2.94%). I ntraoperatively, the following were found: hemoperitoneum-30(88.23%), retroperitoneal hematoma-26 (76.47%), retroperitoneal phlegmon-3 (8.82%), diffuse peritonitis-6 (17.64%), imbibition retroperitoneal bile-4 (11.76%). Surgical treatment was performed according to the degree of duodenal damage. In the first degree: duodenorrhaphy–12 (35.29%), evacuation of ret roperitoneal hematoma–1 (2.94%). In the II degree: duodenoraphys–5 (14.07%), antrumresectio n with a GEA–1 (2.94%). In degree III: duodenoraphs–5 (14.07%), with a GEA according to Braun – 2 (5. 88%), In degree IV: duodenoraphs–2 (5.88%) with the exclusion of the duodenum from t he passage and GEA. In grade V: exclusion of the duodenum with GEA with EEA -1 (2.94%). Pos toperative complications were manifested by wound suppuration–2, suture dehiscence–4, duodenal fistul a–4, retroperitoneal phlegmon–1, intraperitoneal abscesses–5, evolving peritonitis–8, sepsis–2. Relaparotomy as a result of the complications occurred in 13 patients, the l ethality constituting 16 cases. Conclusion. Duodenal lesions represent a challenge in diagnosis, having non-specific symptoms and lack of obvious signs. The study emphasizes the severit y of these injuries in abdominal trauma, with a great influence on lethality. Early identificatio n and appropriate surgical intervention are essential to improve the prognosis of patients with duodena l injuries caused by road traffic accidents.