Injury of duodenum

[Christos Giannou]

Dear colleagues,

Patient has a 0.45 calibre gunshot wound to the abdomen. Injury of Vena cava
and duodenum 4th part. Correct?

quote
Difficult duodenal repair for injury to the 4th portion not involving
the pancreas and remote to the ampulla. Through and through 45 caliber
gunshot wound suture closure but concern for the repair. Vena cava also
repaired.
unquote

I am a bit confused, being an "old school" surgeon. My understanding of
damage control surgery is control haemorrhage, control contamination. Stop
operation. Correct hypothermia, acidosis and coagulopathy. Then, do a
definitive repair.

You have controlled haemorrhage from the Vena Cava, and performed a repair.
(Aorta is intact?) Bravo!!!!  How long has the operation taken so far? How
much blood has the patient received?

At this point, personally, I would tie off the two ends of the duodenal
injury with a simple ligature, or place haemostatic clamps on them (I do not
have a stapling device.). = control of contamination. End of operation, get
out of the abdomen.

Twenty-four to 48 hours later, patient stabilised, I would then go in a
second time for the "difficult duodenal repair". At which point, we have a
simple question of how best to protect an anastomosis of the duodenum 4, in
a stable patient. Why on earth would you perform a difficult intestinal
anastomosis during a first stage damage control procedure?

Have I missed something in this discussion? Best regards,

-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18