Pyloric exclusion in the management of duodenal trauma: Is concomitant gastrojejunostomy necessary?

Enrique Ginzburg, Eddy H. Carrillo, Jorge L. Sosa, Jeff Hertz, Itzhak Nir, Larry C. Martin

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Pyloric exclusion with gastrojejunostomy (PE-GJ) has been recommended in patients with severe injuries to the pancreatoduodenal complex. Recently, the management philosophy for pancreatoduodenal injuries has been that less treatment is probably the best treatment. But whether gastrojejunostomy (GJ) should be used routinely with pyloric exclusion (PE) remains controversial. A retrospective review was conducted of patients who underwent PE at a Level I trauma center during a 36-month period. Forty-five patients had duodenal injuries and 12 of these (27%) underwent PE for management of complex duodenal injuries. Gunshot wounds were the cause of the injuries in 10 of the 12 patients (83%). Eight patients (67%) underwent PE-GJ and had a mean hospital stay of 25 days. Four patients (33%) underwent PE alone and had a mean hospital stay of 29 days. All 12 patients had spontaneous opening of the PE, regardless of the technique used. One patient (12.5%) in the PE-GJ group developed marginal ulceration and significant hemorrhage, and one patient died in the PE-GJ group. The reported incidence of marginal ulceration in the PE-GJ group, the spontaneous opening of the pylorus, and the need to limit the extent of surgical repair to focus on all other associated lesions present in these patients, suggest that GJ should not be used routinely in patients undergoing PE for the management of severe pancreatoduodenal injuries.

Original languageEnglish (US)
Pages (from-to)964-966
Number of pages3
JournalAmerican Surgeon
Volume63
Issue number11
StatePublished - Nov 12 1997

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Pyloric exclusion in the management of duodenal trauma: Is concomitant gastrojejunostomy necessary?'. Together they form a unique fingerprint.

  • Cite this

    Ginzburg, E., Carrillo, E. H., Sosa, J. L., Hertz, J., Nir, I., & Martin, L. C. (1997). Pyloric exclusion in the management of duodenal trauma: Is concomitant gastrojejunostomy necessary? American Surgeon, 63(11), 964-966.