The impact of delayed diagnosis in retroperitoneal duodenal trauma

Abstract

Introduction. The issue of diagnosing traumatic retroperitoneal duodenal injuries is current and quite significant, considering the vague clinical signs, the ensuing complications, and the associated postoperative mortality. Aim of study. Studying the diagnosis of evolutionary peculiarities of traumatic retroperitoneal lesions of the duodenum by analyzing the methods used for establishing the clinical diagnosis. Methods and materials. This retrospective study comprises the examination of medical files from 29 patients with retroperitoneal duodenal trauma who were hospitalized at the Institute of Emergency Medicine between 1992-2017. Ratio: M:W- 25:4, age 18-70 years. Among these patients, 18 (62.06%) presented with polytrauma, while 11 (37.9%) had isolated abdominal trauma. Trauma mechanisms included road accidents in 10 cases (34.48%), falls from height in 3 cases (10.34%), physical assaults in 5 cases (17.24%), injuries due to foreign bodies in 1 case (3.44%), knife wounds in 7 cases (24.13%), firearm injuries in 2 cases (6.89%), waterjet-related trauma in 1 case (3.44%), and injuries necessitating interhospital transfer in 9 cases (31.03%). Regarding hospital admission, 25 patients (86.2%) were hospitalized within 6 hours, 4 patients (13.79%) after 48 hours, and 11 patients (37.93%) were admitted after 72 hours with signs of intoxication. Hemodynamic stability was noted in 15 patients (51.7%), while 14 patients (48.27%) presented with hemodynamic instability. Diagnostic evaluations were performed in 22 of the patients (75.8%). Results. Clinical diagnostics were tailored to each case, including abdominal X-rays in 10 patients (detecting pneumoperitoneum and retroperitoneal abnormalities), USG in 14 patients (free fluid in 10), and CT scans in 7 patients (revealing one duodenal lesion, free fluid in 4, pneumoperitoneum in 3, retroperitoneal changes in 4, and one retroperitoneal hematoma). Diagnostic laparoscopy in 5 patients identified conditions like hemoperitoneum (2 cases), peritonitis (2 cases), and duodenal lesions (1 case). Intraoperatively, duodenal lesion locations were determined: D1 in 7 cases (13.7%), D2 in 13 (41.82%), D3 in 10 (34.48%), and D4 in 2 (8.33%). The mortality rate was 55.17%. Conclusion. This comprehensive analysis underscores the criticality of tailored diagnostic approaches in managing traumatic retroperitoneal duodenal injuries, highlighting a notable mortality rate of 55.17% that emphasizes the urgent need for early detection and intervention in these complex cases. quite significant, considering the vague clinical signs, the ensuing complications, and the associated postoperative mortality. Aim of study. Studying the diagnosis of evolutionary peculiarities of traumatic retroperitoneal lesions of the duodenum by analyzing the methods used for esta blishing the clinical diagnosis. Methods and materials. This retrospective study comprises the examination of med ical files from 29 patients with retroperitoneal duodenal trauma who were hos pitalized at the Institute of Emergency Medicine between 1992-2017. Ratio: M:W- 25:4, age 18-70 years . Among these patients, 18 (62.06%) presented with polytrauma, while 11 (37.9%) had isolated abdominal trauma. Trauma mechanisms included road accidents in 10 case s (34.48%), falls from height in 3 cases (10.34%), physical assaults in 5 cases (17.24%), injuries due to foreign bodies in 1 case (3.44%), knife wounds in 7 cases (24.13%), firearm injuries in 2 c ases (6.89%), waterjet-related trauma in 1 case (3.44%), and injuries necessitating interhos pital transfer in 9 cases (31.03%). Regarding hospital admission, 25 patients (86.2%) were hospit alized within 6 hours, 4 patients (13.79%) after 48 hours, and 11 patients (37.93%) were admitted a fter 72 hours with signs of intoxication. Hemodynamic stability was noted in 15 patients (51.7%), while 14 patients (48.27%) presented with hemodynamic instability. Diagnostic evaluat ions were performed in 22 of the patients (75.8%). Results. Clinical diagnostics were tailored to each case, incl uding abdominal X-rays in 10 patients (detecting pneumoperitoneum and retroperitoneal abnormaliti es), USG in 14 patients (free fluid in 10), and CT scans in 7 patients (revealing one duodenal lesion, free fluid in 4, pneumoperitoneum in 3, retroperitoneal changes in 4, and one retroperitoneal hematoma). Diagnostic laparoscopy in 5 patients identified conditions like hemoperitoneum (2 ca ses), peritonitis (2 cases), and duodenal lesions (1 case). Intraoperatively, duodenal lesion locati ons were determined: D1 in 7 cases (13.7%), D2 in 13 (41.82%), D3 in 10 (34.48%), and D4 in 2 (8.33%). The mortality rate was 55.17%. Conclusion. This comprehensive analysis underscores the criticality of tailored diagnostic approaches in managing traumatic retroperitoneal duodenal inj uries, highlighting a notable mortality rate of 55.17% that emphasizes the urgent need fo r early detection and intervention in these complex cases.