Diagnosis and treatment of duodenal injury and fistula.
- Author:
Kunmei GONG
1
;
Shikui GUO
1
;
Kunhua WANG
2
Author Information
1. Department of General Surgery, The First People's Hospital of Yunnan Province, Kunming 650032, China.
2. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, China. wangkunhua@medmail.com.cn.
- Publication Type:Journal Article
- MeSH:
Abdominal Injuries;
complications;
Anti-Infective Agents;
therapeutic use;
Decompression, Surgical;
Digestive System Surgical Procedures;
adverse effects;
methods;
Drainage;
Duodenal Diseases;
diagnosis;
etiology;
prevention & control;
therapy;
Duodenum;
blood supply;
injuries;
surgery;
Enteral Nutrition;
Humans;
Hypoproteinemia;
therapy;
Intestinal Fistula;
diagnosis;
etiology;
prevention & control;
therapy;
Ischemia;
prevention & control;
Nutritional Support;
Parenteral Nutrition;
Postoperative Complications;
prevention & control;
therapy;
Suture Techniques;
Thoracic Injuries;
complications
- From:
Chinese Journal of Gastrointestinal Surgery
2017;20(3):266-269
- CountryChina
- Language:Chinese
-
Abstract:
Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
