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Trauma de duodeno: análise de fatores relacionados à morbimortalidade

DOI: 10.1590/S0100-69912008000200006

Keywords: duodenum [injuries], fistula, wounds & injuries, trauma severity indices.

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background: duodenal injuries remain one of the most complex challenges for trauma surgeons. the aim of this study is to evaluate factors that predict morbidity and mortality for duodenal trauma patients. methods: a registry-based retrospective analysis of data identified 77 patients with duodenal injuries in a university hospital from january 1990 to december 2005. grade i injuries were excluded. results: the injury trauma mechanism was penetrating in 87% and blunt in 13%. there was no difference in mortality based on trauma mechanisms. delayed operation more than 6 hours after injury was observed in 7.8% of patients, and it was not related to patient outcomes. we performed primary simple repair for duodenal injury in 84.4% and complex repair in 15.6% of the patients. the latter had higher morbidity. mean ati was 34.5 and mean iss was 22.8. overall morbidity and mortality rate were, respectively, 61% and 27.3%. most of no survivors were with hypovolemic shock at admission, they had lower rts, higher ati and iss, and they had lower triss than survivors. hypovolemic shock, altered rts, associated injuries, and probability of survival less than 50% were independently factors related to death. conclusion: morbidity following duodenal trauma was more dependent on associated intra-abdominal injuries, abdominal contamination and complex repair. physiologic presentation, associated injuries (iss > 25), and triss were important factors for predicting morbidity and mortality for traumatic duodenal injuries.


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