For the Medical Practitioners
doi: 10.25005/2074-0581-2022-24-3-394-403
CHALLENGES IN THE DIAGNOSTICS AND TREATMENT OF DUODENUM INJURIES IN CHILDREN

A.A. Gumerov1, I.A. Komissarov2, R.A. Gumerov3, T.S. Psyanchin3, I.I. Khidiyatov1, S.V. Gabdullina3

1Bashkir State Medical University, Ufa, Republic of Bashkortostan, Russian Federation
2Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation
3Republican Children's Clinical Hospital, Ufa, Republic of Bashkortostan, Russian Federation

Objective: To study the clinical presentations and diagnosis of injuries to the duodenum in children.

Methods: The study analyses the diagnosis and treatment of duodenal injuries in 14 children admitted to pediatric surgery departments at the Bashkir State Medical University, Ufa, Russia and Saint-Petersburg State Pediatric Medical University, Russia, between 2000 and 2020. The clinical presentations of duodenal injuries, diagnostic challenges and preoperative and intraoperative errors were evaluated.

Results: High diagnostic error rates were observed since practitioners have a knowledge gap regarding the clinical presentation and surgical treatment principles of duodenal trauma among affected children. The authors believe that the presence of one of the symptoms (retroperitoneal hematoma, emphysema, yellowish green staining of the retroperitoneum and tissues is an indication for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre.

Conclusion: Damage to the duodenum in children presents considerable difficulties in diagnosis and treatment. In this regard, imaging studies should be employed for diagnosis. Diagnostic laparoscopy is considered the gold standard for preoperative clinical evaluation. Retroperitoneal hematoma and/or emphysema, and yellow-green staining of the retroperitoneum and tissues, are indications for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre.

Keywords: Duodenum, trauma, diagnosis, surgical treatment.

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References
  1. Schiller B, Radke M, Hauenstein C, Müller C, Spang C, Reuter DA, et al. Large duodenal hematoma causing an ileus after an endoscopic duodenal biopsy in a 6-year-old child: A case report. Medicina (Kaunas). 2021;58(1):12. Available from: https://doi.org/10.3390/medicina58010012
  2. Garside G, Khan O, Mukhtar Z, Sinha C. Paediatric duodenal injury complicated by common bile duct rupture due to blunt trauma: A multispecialist approach. BMJ Case Rep. 2018;2018:bcr2018225221. Available from: https://doi. org/10.1136/bcr-2018-225221
  3. Correia Sousa Périssé JP, de Carvalho Miranda Rosati Rocha AL, Lessa Coelho R, Guerra Campanario B, Rosati Rocha LF. Duodenal laceration due to blunt trauma caused by horse kick: A case report and literature review. Am J Case Rep. 2020;21:e927461. Available from: https://doi.org/10.12659/AJCR.927461
  4. Chakravorty S, Basu KS, Biswas SK, Bisth J, Ghosh D, Saha K. Pancreatico duodenal trauma in children: Two-year experience at a regional referral center and tertiary care teaching hospital. J Indian Assoc Pediatr Surg. 2020;25(3):151-4. Available from: https://doi.org/10.4103/jiaps.JIAPS_64_19
  5. Lesher A, Williams R. Pancreatic and duodenal trauma in children. J Pediatr Intensive Care. 2015;4(1):21-6. Available from: https://doi. org/10.1055/s-0035-1554985
  6. Luo Y, He X, Geng L, Ouyang R, Xu Y, Liang Y, et al. Diagnosis and treatment of traumatic duodenal rupture in children. BMC Gastroenterol. 2022;22(1):61. Available from: https://doi.org/10.1186/s12876-022-02136-w
  7. García Santos E, Soto Sánchez A, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: Review of the literature. Cir Esp. 2015;93(2):68- 74. Available from: https://doi.org/10.1016/j.ciresp.2014.08.004
  8. Khasanov AG, Matigullin RM, Sufiyarov IF. Duodenal'naya travma [Duodenal trauma]. UFA, RF: Izdatel'stvo «Gilem»; 2015. 118 p.
  9. Kurbonov KM, Norov KhM, Gulov MK. Tekhnika operatsiy na distal'nom otdele kholedokha i bol'shom sosochke dvenadtsatiperstnoy kishki pri eyo postbul'barnykh yazvakh [Technique of operations on the distal part of the common bile duct and the major papilla of the duodenum with its post-bulbar ulcers]. Annaly khirurgicheskoy gepatologii. 2004;9(1):120.
  10. Gaines BA, Shultz BS, Morrison K, Ford HR. Duodenal injuries in children: beware of child abuse. J Pediatr Surg. 2004;39(4):600-2. Available from: https:// doi.org/10.1016/j.jpedsurg.2003.12.010
  11. Goh B, Soundappan SSV. Traumatic duodenal injuries in children: a single- centre study. ANZ J Surg. 2021;91(1-2):95-9. Available from: https://doi. org/10.1111/ans.16502
  12. Clendenon JN, Meyers RL, Nance ML, Scaife ER. Management of duodenal injuries in children. J Pediatr Surg. 2004;39(6):964-8. Available from: https://doi. org/10.1016/j.jpedsurg.2004.02.032
  13. Gutierrez IM, Mooney DP. Operative blunt duodenal injury in children: a multi-institutional review. J Pediatr Surg. 2012;47(10):1833-6. Available from: https://doi.org/10.1016/j.jpedsurg.2012.04.013
  14. Desai KM, Dorward IG, Minkes RK, Dillon PA. Blunt duodenal injuries in children. J Trauma. 2003;54(4):640-5. Available from: https://doi.org/10.1097/01. TA.0000056184.80706.9B
  15. Diao M, Li L, Cheng W. Single-Incision Laparoscopic Repair for Iatrogenic Duodenal Injury in Children with Choledochal Cysts. J Laparoendosc Adv Surg Tech A. 2019;29(6):869-72. Available from: https://doi.org/10.1089/lap.2018.0692
  16. Sowrey L, Lawson KA, Garcia-Filion P, Notrica D, Tuggle D, Eubanks JW 3rd, Maxson RT, Recicar J, Megison SM, Garcia NM. Duodenal injuries in the very young: child abuse? J Trauma Acute Care Surg. 2013;74(1):136-41. Available from: https://doi.org/10.1097/TA.0b013e3182788cb2
  17. Katz MG, Fenton SJ, Russell KW, Scaife ER, Short SS. Surgical outcomes of pancreaticoduodenal injuries in children. Pediatr Surg Int. 2018; 34(6):641-5. Available from: https://doi.org/10.1007/s00383-018-4249-x

Authors' information:

Gumerov Aitbay Akhmetovich
Doctor of Medical Sciences, Full Professor, Professor of the Department of Pediatric Surgery with Physical and Medical Rehabilitation of Children with the Course of IDPO, Bashkir State Medical University
Researcher ID: B-8210-2018
Scopus ID: 7004230973
ORCID ID: 0000-0001-6183-8286
SPIN: 7615-7568
Author ID: 527877
E-mail: prof.gumerov@gmail.com

Komissarov Igor Alekseevich
Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases of Childhood, St. Petersburg State Pediatric Medical University
SPIN: 3356-9330
E-mail: komissarov_i_a@mail.ru

Gumerov Ramil Aitbaevich
Doctor of Medical Sciences, Head of the Department of Radiation Diagnostics, Republican Children's Clinical Hospital
ORCID ID: 0000-0001-9991-6630
E-mail: r.a.gumerov@gmail.com

Psyanchin Timur Syntimerovich
Candidate of Medical Sciences, Head of the Department of Traumatology and Orthopedics, Republican Children's Clinical Hospital
E-mail: pedsurg@bk.ru

Gabdullina Sabina Vilevna
Resident of the Department of Surgery, Republican Children's Clinical Hospital
E-mail: gab.sabina04@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Gumerov Aitbay Akhmetovich
Doctor of Medical Sciences, Full Professor, Professor of the Department of Pediatric Surgery with Physical and Medical Rehabilitation of Children with the Course of IDPO, Bashkir State Medical University

450105, Russian Federation, Republic of Bashkortostan, Ufa, Stepan Kuvykin str., 98

Tel.: +7 (963) 9056575

E-mail: prof.gumerov@gmail.com

Materials on the topic:
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  2. SURGICAL MANAGEMENT OF POST-BURN SCAR EXTENSION CONTRACTURES OF THE TOES
  3. GIANT FRONTOETHMOIDAL OSTEOMAS: A RATIONAL APPROACH TO THE SURGICAL REMOVAL AND THE IMMEDIATE RECONSTRUCTION OF THE ANTERIOR WALL OF THE FRONTAL SINUS
  4. THE LATISSIMUS DORSI MUSCLE FLAP TRANSFER IN SURGICAL CORRECTION OF POST-TRAUMATIC UPPER LIMB DYSFUNCTION
  5. NERVE TRANSFER IN IRREVERSIBLE INJURIES OF UPPER LIMB NERVE: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVE
  6. SURGICAL REPAIR OF LATERAL AND ANTEROLATERAL HERNIAS OF THE ABDOMINAL WALL
  7. RESULTS OF LAPAROSCOPIC AND CONVENTIONAL HERNIOPLASTY IN OLDER PATIENTS AND MORPHOLOGICAL CHANGES IN THE TISSUES OF THE INGUINAL CANAL
  8. IMMEDIATE RESULTS OF URETROPLASTY IN DIFFERENT FORMS OF HYPOSPADIAS
  9. ANALYSIS OF THE EFFICIENCY OF APPLICATION OF THE TWO SURGERY METHODS OF TREATMENT OF THE URETHRAL INJURY CONSEQUENCES
  10. THE OUTCOMES OF THE FOREARM FLAP APPLICATIONS IN THE UPPER LIMB SEVERE INJURIES RECONSTRUCTION

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