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Table 3 Characteristics of endoscopically induced duodenal injuries, Cairns Base Hospital, 2002–2008

From: Endoscopic duodenal perforation: surgical strategies in a regional centre

Case (year) 1 (2002) 2 (2004) 3 (2005) 4 (2006) 5 (2007)
Age/Sex 51 male 69 male 42 female 61 female 72 male
Indication for ERCP/endoscopy Post-cholecystectomy pain Choledocholithiasis Post- cholecystectomy pancreatitis Choledocholithiasis Post-cholecystectomy pain
Post-procedure symptoms, signs Severe abdominal pain, tachycardia Severe abdominal pain Mild abdominal pain Abdominal pain Abdominal pain
Type of perforation Not identified Not identified (Duodenal diverticulum) Type 2 (see Results) Not identified Type 1 (see Results) (Duodenal diverticulum)
Delay to Diagnosis/Intervention 48 hours then 5 weeks 5 days Immediate diagnosis Immediate diagnosis, surgery within 24 hours Immediate diagnosis, surgery at 6 hours
Indications for surgery a) Duodenal perforation a) Duodenal perforation Nil a) Duodenal perforation a) Large defect duodenum,
a) at diagnosis b) Infected retroperitoneal necrosis/collections b) Extensive retroperitoneal necrosis/collections Persistent duodenal leak    b) Extensive retroperitoneal necrosis/collections
b) subsequent Duodenal stenosis, Necrosis of posterior caecal wall    b) Extensive retroperitoneal necrosis a) Laparotomy, repair duodenum
Management a) Laparotomy a) Laparotomy Conservative a) Laparotomy, retroperitoneal washout, pyloric, exclusion, gastrojejunostomy, jejunal feeding tube b) Open drainage/evacuation right retroperitoneal space x 2
a) on diagnosis b) Attempted percutaneous drainage b) 7 x debridement of necrosis (no surgery)   Drainage right scrotum
b) subsequent 2 x Open drainage procedure right retroperitoneal space Open drainage right inguinoscrotal tract    
  Right hemicolectomy, end ileostomy and mucous fistula Pyloric exclusion, gastrojejunostomy    
Complications of treatment Deep vein thrombosis Gastroparesis, UTI, CVL infection, wound infection, left brachial plexopathy Nil Necrotising fasciitis right thigh/abdomen Right inguinal haematoma
Incisional hernia
Seroma
Length of stay (days) 99 132 4 6 63
Case fatality No No No Yes No
Residual disability Residual presacral collection and sinus to right iliac fossa Retained CBD stones removed 2007 Nil Died Nil