How are duodenal trauma managed? A French nationwide study

Sébastien Frey; Imad Bentellis; Sébastien Gaujoux; Edouard Girard; Julio Abba; Mircea Chirica; Martin Bertrand; Etienne Boutry; Diane Mège; Mathilde Aubert; Arnaud Alves; Emmanuel Hornez; Andrea Mulliri; Raffaele Brustia; Hassen Hentati; Lelde Lauka; Alexis Laurent; Daniele Sommacale; Célia Turco; Maude Dezeustre; Melinda Bajul; Antoine Castel; Olivier Facy; Robin Grellet; Laurent Sulpice; Fabrice Ménégaux; Maxime Delestre; Emilie Lermite; Tristan Monchal; Rida Amrou; Ophélie Bacoeur-Ouzillou; Denis Pezet; Jeremy Bonnet; Emmanuel Buc; Guillaume Passot; Anne-Sophie Schneck; David Jérémie Birnbaum; Pierre-Yves Blanc; Bertrand Le Roy; Olivier Monneuse; Quentin Rodriguez; Bertrand Suc; Patrick Baqué; Vincent Dubuisson; Damien Massalou

doi:10.1186/s13017-025-00661-z

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How are duodenal trauma managed? A French nationwide study

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How are duodenal trauma managed? A French nationwide study

Sébastien Frey, Imad Bentellis, Sébastien Gaujoux, Edouard Girard, Julio Abba, Mircea Chirica, Martin Bertrand, Etienne Boutry, Diane Mège, Mathilde Aubert, …

World journal of emergency surgery, Vol.20(1), pp.89-11

09/12/2025

DOI: https://doi.org/10.1186/s13017-025-00661-z

PMID: 41366408

Résumé

Abdominal Injuries

Adolescent

Adult

Duodenum - injuries

Duodenum - surgery

Female

France - epidemiology

Humans

Injury Severity Score

Male

Middle Aged

Retrospective Studies

Trauma Centers - organization & administration

Trauma Centers - statistics & numerical data

Duodenal injuries are rare, associated with a significant morbidity. Their management is challanging and remains controversial. A retrospective study of all consecutive patients with duodenal trauma managed in 21 French trauma centers from 2004 to 2023. Clinical data, trauma mechanisms, injury severity, treatment modalities and outcomes were collected. Specific attention was given to surgical techniques such as damage control laparotomy, primary repair only and duodenal diversion. Statistical analysis was performed to identify factors associated with duodenal leak, severe morbidity and mortality. One hundred and thirty-five patients (71.7% male, mean age 35 years) were included, 64% with blunt trauma. Duodenal AAST grades I-II occurred in 68.2% and grades III-V in 31.8%. A discrepancy between radiologic evaluation and intraoperative observations was present in 30.8% of cases, underestimating injury severity in 29.1%. Initial management was nonoperative for 12.7%. Damage control laparotomy was required in 36.6%. Operated patients underwent direct suture (69.2%), duodenal resection (24.4%), duodenal diversion (35.8%). Duodenal leaks occurred in 23.7%, significantly increased by hemodynamic instability (OR = 3.08, p = 0.015) and associated pancreatic trauma (OR = 2.44, p = 0.044). Reoperation rate was 18.5%, for missed duodenal injury (16%) and/or for duodenal leak (32%). Mean length of stay was 27 days. Major morbidity was 27.4% and 30-day mortality 10.4%. The injury severity score was the only predictive factor of major morbidity and mortality. Duodenal trauma remains a severe condition managed mostly with primary repair, where duodenal leak-significantly associated with hemodynamic instability and pancreatic injury, is a major driver of reintervention. This study was registered on Clinical Trials under the registration numbe NCT06058975.

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Titre: How are duodenal trauma managed? A French nationwide study
Créateurs - sans rôle: Sébastien Frey - Department of Digestive Surgery, University Hospital of Nice, Pasteur Hospital, Nice, France. freysebastien6@gmail.com
Imad Bentellis - Department of Urology, Clinique Saint-Jean, Cagnes-Sur-Mer, France
Sébastien Gaujoux - Assistance Publique – Hôpitaux de Paris
Edouard Girard - Department of Digestive and Emergency Surgery, University Hospital of Grenoble Alpes, TIMC, Grenoble, France
Julio Abba - Department of Digestive and Emergency Surgery, University Hospital of Grenoble Alpes, TIMC, Grenoble, France
Mircea Chirica - Department of Digestive and Emergency Surgery, University Hospital of Grenoble Alpes, TIMC, Grenoble, France
Martin Bertrand - Department of Digestive and Oncological Surgery, University Hospital of Nîmes, Nîmes, France
Etienne Boutry - Department of Digestive and Oncological Surgery, University Hospital of Nîmes, Nîmes, France
Diane Mège - Department of Digestive and Oncological Surgery, Timone Hospital, University Hospital of Marseille, Marseille, France
Mathilde Aubert - Department of Digestive and Oncological Surgery, Timone Hospital, University Hospital of Marseille, Marseille, France
Arnaud Alves - Inserm Unity UMR 1086, ANTICIPE, Caen, France
Emmanuel Hornez - Department of Visceral and Digestive Surgery, Percy Military Teaching Hospital, Clamart, France
Andrea Mulliri - Department of Digestive Surgery, University of Caen Normandie, Caen, France
Raffaele Brustia - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Hassen Hentati - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Lelde Lauka - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Alexis Laurent - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Daniele Sommacale - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Célia Turco - Department of Digestive and Oncologic Surgery - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
Maude Dezeustre - Department of Digestive and Oncologic Surgery - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
Melinda Bajul - Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
Antoine Castel - Department of Hepatobiliary and Digestive Surgery, University Hospital of Rennes, Rennes, France
Olivier Facy - Department of Digestive and Oncological Surgery, University Hospital of Dijon, Dijon, France
Robin Grellet - Department of Digestive and Oncological Surgery, University Hospital of Dijon, Dijon, France
Laurent Sulpice - Department of Hepatobiliary and Digestive Surgery, University Hospital of Rennes, Rennes, France
Fabrice Ménégaux - Assistance Publique – Hôpitaux de Paris
Maxime Delestre - Department of Digestive and Visceral Surgery, University Hospital of Angers, Angers, France
Emilie Lermite - Department of Digestive and Visceral Surgery, University Hospital of Angers, Angers, France
Tristan Monchal - Department of Visceral, Digestive, and Oncological Surgery, Sainte-Anne Military Teaching Hospital, Toulon, France
Rida Amrou - Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
Ophélie Bacoeur-Ouzillou - Department of Digetive and Hepatobiliary Surgery, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Denis Pezet - Department of Digetive and Hepatobiliary Surgery, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Jeremy Bonnet - Department of Digestive Surgery, University Hospital of Guadeloupe, Pointe-À-Pitre, France
Emmanuel Buc - Department of Digetive and Hepatobiliary Surgery, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
Guillaume Passot - Department of Digestive and Oncological Surgery, University Hospital of Lyon Sud, Lyon, France
Anne-Sophie Schneck - Department of Digestive Surgery, University Hospital of Guadeloupe, Pointe-À-Pitre, France
David Jérémie Birnbaum - Department of Visceral and Digestive Surgery, Hôpital Nord, University Hospital of Marseille, Marseille, France
Pierre-Yves Blanc - Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
Bertrand Le Roy - Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Etienne, France
Olivier Monneuse - Emergency Surgical Departement, Trauma Center, Edouard Herriot Hospital, Université Claude Bernard Lyon 1, Lyon, France
Quentin Rodriguez - Department of Digestive Surgery and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
Bertrand Suc - Department of Digestive Surgery and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
Patrick Baqué - Department of Digestive Surgery, University Hospital of Nice, Pasteur Hospital, Nice, France
Vincent Dubuisson - Department of Digestive Surgery, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
Damien Massalou - ICARE Lab, Inserm, U1091 (IBV), Nice, France
Détails de publication: World journal of emergency surgery, Vol.20(1), pp.89-11
Identifiants: 99155050109311
Unité académique: Initial MAnagement & prevent of acute orGan failures IN critically ill patiEnts - IMAGINE
Langue: English
Type de ressource: Journal article