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Duodenal trauma
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of duodenal trauma are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2019).
1
Diagnostic investigations
Ultrasound
As per AAST/WSES 2019 guidelines:
Obtain eFAST for detecting free fluid and solid organ injury.
A
Do not obtain routine ultrasound for the diagnosis of duodeno-pancreatic trauma. Consider obtaining contrast-enhanced ultrasound in stable patients with trauma with suspected pancreatic injury.
D
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CT
Abdominal radiography
Diagnostic procedures
Medical management
Surgical interventions
Exploratory laparotomy: as per AAST/WSES 2019 guidelines, perform exploratory laparotomy in hemodynamically unstable (WSES class IV) patients with a positive eFAST.
A
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Indications for surgery
Specific circumstances
Pediatric patients
As per AAST/WSES 2019 guidelines:
Manage pediatric patients with duodenal-pancreatic trauma by specialists with specific skills and only in trauma centers.
B
Obtain ultrasound with or without contrast enhancement as the diagnostic modality of choice for follow-up imaging in pediatric patients. Prefer MRI if cross-sectional imaging is required.
B
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Pregnant patients
Patients with pancreatic injury (evaluation)
Patients with pancreatic injury (nonoperative management)
Patients with pancreatic injury (operative management)