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- Title
Complicated duodenal perforation in children: Role of T-tube.
- Authors
Keshri, Rupesh; Chaubey, Digamber; Yadav, Ramdhani; Kumar, Vijayendra; Thakur, Vinit Kumar; Ranjana, Rashmi; Rahul, Sandip Kumar
- Abstract
<bold>Background: </bold>Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure.<bold>Objectives: </bold>To explore the advantages of using T-tube in surgeries for DP in children.<bold>Patients and Methods: </bold>A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected. Patients, with closure over a T-tube to ensure tension-free healing, were critically analysed.<bold>Results: </bold>A total of nine DP patients with ages ranging from 2 years to 9 years were managed. Five (55.6%) patients had blunt abdominal trauma; a 2-year-old male had perforation following accidental ingestion of lollypop-stick while a 3-year-old male had DP during endoscopic evaluation (iatrogenic) of bleeding duodenal ulcers; cause could not be found in other 2 (22.2%) patients. Of the five patients with blunt abdominal trauma, 4 (80%) had large perforation with oedematous bowel, necessitating repair over T-tube. Both patients with unknown causes had uneventful outcomes following primary repair with Graham's patch. Patients with lollypop-stick ingestion and iatrogenic perforation did well with repair over T-tube. The only trauma patient with primary repair leaked but subsequently had successful repair over a T-tube. One patient with complete transection of the third part of the duodenum and pancreatic injury who had repair over T-tube died due to secondary haemorrhage on the 10th post-operative day.<bold>Conclusion: </bold>Closure over a T-tube in DP, presenting late with oedematous bowel, ensures low pressure at the perforation site, forms a controlled fistula and promotes healing, thereby lessening post-operative complications.
- Subjects
BLUNT trauma; PEPTIC ulcer perforation; IATROGENIC diseases; RETROSPECTIVE studies; DUODENUM; DUODENAL ulcers; INTESTINAL perforation; ABDOMINAL injuries
- Publication
African Journal of Paediatric Surgery, 2022, Vol 19, Issue 4, p217
- ISSN
0189-6725
- Publication type
journal article
- DOI
10.4103/ajps.ajps_74_21