PYLORIC EXCLUSION IN THE MANAGEMENT OF DUODENAL TRAUMA - IS CONCOMITANT GASTROJEJUNOSTOMY NECESSARY

Pyloric exclusion with gastrojejunostomy (PE-GJ) has been recommended in patients with severe injuries to the pancreatoduodenal complex. Rec ently, the management philosophy for pancreatoduodenal injuries has be en that less treatment is probably the best treatment. But whether gas trojejunostomy (GJ) should be used routinely with pyloric exclusion (P E) remains controversial. A retrospective review was conducted of pati ents who underwent PE at a Level I trauma center during a 36-month per iod. Forty-five patients had duodenal injuries and 12 of these (27%) u nderwent PE for management of complex duodenal injuries. Gunshot wound s 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 day s. Four patients (33%) underwent PE alone and had a mean hospital stay of 29 days. All 12 patients had spontaneous opening of the PE, regard less of the technique used. One patient (12.5%) in the PE-GJ group dev eloped marginal ulceration and significant hemorrhage, and one patient died in the PE-GJ group. The reported incidence of marginal ulceratio n 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 asso ciated lesions present in these patients, suggest that GJ should not b e used routinely in patients undergoing PE for the management of sever e pancreatoduodenal injuries.