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ISRN Pediatrics
Volume 2012 (2012), Article ID 298753, 4 pages
http://dx.doi.org/10.5402/2012/298753
Research Article

Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children

1University of Kentucky College of Medicine, Lexington, KY 40536, USA
2Department of Pediatrics, University of Kentucky, Lexington, KY 40536-0298, USA
3Kentucky Children's Hospital and Chandler Medical Center, University of Kentucky, Lexington, KY 40536-0298, USA
4Division of Pediatric Surgery, Department of Surgery, University of Kentucky, Lexington, KY 40536-0298, USA

Received 14 September 2012; Accepted 8 October 2012

Academic Editors: M. Sánchez-Solís and B. Vasarhelyi

Copyright © 2012 Katherine Smiley et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons’ Trauma Center database for the years 2003–2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I–IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries.