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Duodenal trauma

Key sources
The following summarized guidelines for the evaluation and management of duodenal trauma are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2019).
1

Guidelines

1.Diagnostic investigations

Ultrasound
Obtain eFAST for detecting free fluid and solid organ injury.
A
Do not obtain routine ultrasound for the diagnosis of duodeno-pancreatic trauma. Consider obtaining contrast-enhanced ultrasound in stable patients with trauma with suspected pancreatic injury.
D
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  • CT

  • Abdominal radiography

2.Diagnostic procedures

Peritoneal lavage: recognize that diagnostic peritoneal lavage does not improve the specificity of diagnosing duodeno-pancreatic injury, and it is sensitive but not specific for biliary tract injury.
B

3.Medical management

Nonoperative management: use hemodynamic stability as the key factor in determining management strategy in patients with duodenal injury.
B
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4.Surgical interventions

Exploratory laparotomy: perform exploratory laparotomy in hemodynamically unstable (WSES class IV) patients with a positive eFAST.
A
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  • Indications for surgery

5.Specific circumstances

Pediatric patients
Manage pediatric patients with duodenal-pancreatic trauma by specialists with specific skills and only in trauma centers.
B
Obtain ultrasound with or without contrast enhancement as the diagnostic modality of choice for follow-up imaging in pediatric patients. Prefer MRI if cross-sectional imaging is required.
B

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  • Pregnant patients

  • Patients with pancreatic injury (evaluation)

  • Patients with pancreatic injury (nonoperative management)

  • Patients with pancreatic injury (operative management)

6.Follow-up and surveillance

Serial clinical assessment: perform serial clinical examination during follow-up after biliary and pancreatic-duodenal trauma.
B

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  • Serial imaging assessment