Abstract

Background: Isolated duodenal injury following blunt or penetrating trauma remains an extremely rare and one of the most challenging hitches confronting trauma surgeons. Triple-tube-ostomy (TTO) technique involving gastrostomy, reverse duodenostomy, and feeding jejunostomy tubes insertion has shown promising results during conservative management of duodenal injuries.

Objective: We aim through this paper to report a successfully managed case of isolated incomplete transverse duodenal injury managed by TTO technique in a 14-year-old boy who presented with severe abdominal pain, one day after sustaining ablunt abdominal trauma due to fall from height. In addition, we aimed to systematically review the literature for the usage and outcomes of the TTO surgical procedure, and evaluate its efficiency and effectiveness in the management of duodenal injuries.

Data Sources: OVID/Medline, PubMed, and Scopus databases were lastly searched on December 8th, 2016 to identify all published research studies on duodenal injuries treated by this surgical technique.

Study Selection: Studies reporting cases of duodenal injuries that were managed by TTO were warranting inclusion.

Data Extraction and Synthesis: Both CARE and PRISMA guidelines were followed for conduction and reporting of this study. Throughout the whole review process, two reviewers worked independently and in duplicate to screen titles, assess full texts for eligibility, and abstract data.

Results: Six articles were included in this review. Sixty five cases were reported to have undergone TTO in world literature. Majority of the cases were performed after surgical repair of giant duodenal ulcers, only 2 cases were reported due to perforations following trauma. While majority of cases had uneventful recovery, complications such as wound infections and dehiscence were reported. Mean length of hospital stay was found to be 20.5 days. Mortality occurred in 3 cases.

Conclusions and Relevance: The positive outcomes of our reported case and the structured evaluation of the published studies suggest effectiveness of usage of “triple-tube-ostomy” surgical procedure for management of duodenal injuries. However, further studies are needed to assess the usage of this technique in management of duodenal injuries in comparison to other classical surgical techniques.

Keywords: blunt trauma, abdomen, isolated transverse duodenal transaction, transpyloric “triple-tube-ostomy” decompression, case report, systematic review