Pediatric blunt duodenal injury: a 9-year retrospective single-center series from Vietnam.

BACKGROUND

Pediatric duodenal injury is uncommon, often presents with non-specific features, and is frequently recognized late.

OBJECTIVE

To describe injury patterns, diagnostic imaging, operative strategies (including decompression approaches), and outcomes in children with blunt duodenal injuries.

METHODS

We conducted a retrospective study of consecutive patients aged ≤18 years with blunt abdominal trauma and confirmed duodenal injury treated at a tertiary pediatric hospital in Vietnam (October 2015-May 2024). Demographics, injury characteristics (American Association for the Surgery of Trauma [AAST] grade), imaging findings, management (non-operative vs. operative), decompression approaches, complications, and length of stay (LOS) were extracted from medical records and summarized descriptively.

RESULTS

Fourteen patients were included (mean age 8.8 years). AAST grades I-IV were [3/14 (21.4%)], [6/14 (42.9%)], [4/14 (28.6%)], and [1/14 (7.1%)], respectively. Computed tomography (available in 10/14) frequently demonstrated free intraperitoneal fluid ([10/10, 100%]) and, less commonly, duodenal wall discontinuity ([2/10, 20%]). Non-operative management was used in hematoma-dominant injuries ([3/14, 21.4%]). Surgery was performed in [11/14, 78.6%], most commonly primary repair ([6/11]) or Roux-en-Y duodenojejunostomy ([2/11]). Systematic decompression was applied in all cases: nasogastric tube alone (6/14), nasogastric plus feeding jejunostomy (4/14), nasogastric plus retrograde jejunostomy (1/14), or triple-tube decompression (3/14). Postoperative complications occurred in 7/11 (63.6%, 95% CI: 30.8-89.1%) of surgically managed patients; there were no deaths. Median hospital LOS was 27 days (range 3-92).

CONCLUSIONS

Pediatric blunt duodenal injury should be suspected in children with non-specific abdominal symptoms after blunt trauma. In this series, CT-based assessment and tailored management with decompression were feasible and associated with recovery in all patients.