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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