Successful treatment of victims with closed abdominal trauma with damage to the duodenum (clinical observations)

This article presents two clinical observations of successful treatment of victims with closed abdominal trauma complicated by duodenal injury, with an emphasis on key aspects of treatment and prevention of complications. Injuries to internal organs in closed abdominal trauma pose a serious threat to the lives of victims, especially in cases of damage to the duodenum. Despite the fact that duodenum injuries constitute a relatively small proportion of all abdominal injuries, they are accompanied by a high mortality rate, reaching 30% in isolated injuries and up to 80% in combined injuries. Diagnosis of such injuries is a particular problem. The absence of pathognomonic symptoms, as well as the frequent combination with other injuries (e.g., pancreas, retroperitoneal hematomas, or pelvic fractures) complicates the timely detection of these injuries. In addition, inadequate surgical tactics can lead to severe postoperative complications, including duodenal fistula (2%–16%), intra-abdominal abscess (15%), and pancreatitis (0.5%). The high incidence of severe complications and significant mortality emphasizes the importance of studying effective diagnostic methods, surgical tactics, and postoperative management of patients with duodenal injury. According to the literature, the incidence of duodenal injury in closed abdominal trauma ranges from 0.6 to 5% of all abdominal injuries. The most common injuries are to the retroperitoneal part of the intestine; the horizontal part is injured in 30%–40% of cases, the descending part in 20%–30%, and the upper part in 15%–22%. A significant problem is the recognition of retroperitoneal ruptures in combination with pancreatic injury and the presence of retroperitoneal hematomas caused by kidney injury or pelvic bone fracture. There are no pathognomonic symptoms of duodenal injury.