DUODENAL ORGAN INJURY SEVERITY (OIS) AND OUTCOME

The effect of organ injury severity on outcome was assessed in 101 pat ients treated for duodenal trauma. Most patients were men (89%) and vi ctims of penetrating wounds (93%). Grade I is minor hematoma or incomp lete perforation; Grade II is major hematoma or small complete perfora tion; Grade III is large perforation excluding ampulla; Grade IV is la rge perforation at ampulla; Grade V is duodenopancreatic crunch. The i njuries were as follows: Grade I (5 patients), Grade II (31), Grade II I (40), Grade IV (12), and Grade V (13). Fourteen patients exsanguinat ed from associated vessel injury; each had Grade IV or Grade V injury. All 36 patients with Grade I and Grade II injury had primary repair, the single death was due to liver necrosis. Most (31 patients) Grade I II injuries and three Grade IV injuries were treated by primary repair alone; the three deaths were unrelated to the duodenal injury. Other major injuries were treated by duodenal exclusion (4 patients), duoden al diverticulization (6), or resection (4); the single death was unrel ated to the duodenum. Primary closure is favored for minor injuries an d most Grade III injuries. Severe injuries may require exclusion, dive rticulization, or resection.