Tendencias actuales en el trauma penetrante de duodeno: validando el enfoque de “menos es mejor”

Abstract

Introduction: For penetrating duodenal trauma, an infrequent injury with high morbidity and mortality, surgical management has evolved drastically. Historically, high-grade injuries (AAST III-V) required complex procedures such as pyloric exclusion. However, contemporary evidence and the "less is better" philosophy prioritize simplified primary repair to reduce complications.

Clinical Case: We present the case of a 47-year-old male patient with gunshot wounds, revealing grade III duodenal trauma and grade IV ileal injuries. Under damage control surgery principles, primary duodenal repair, resection with ileal anastomosis, retroperitoneal packing, and temporary abdominal closure were performed. In the intensive care unit, given the limitation of technological resources, resuscitation was successfully guided by peripheral perfusion goals (capillary refill) and bedside ultrasound. Following definitive closure with extraluminal drainage placement at 48 hours, early enteral nutrition was initiated via nasojejunal tube.

Conclusion: This clinical case demonstrates that primary repair is a safe strategy that minimizes surgical morbidity. In resource-limited settings, strict clinical monitoring of perfusion and early nutritional support are fundamental determinants to ensure patient survival.