Incidence and Management of Duodenal Trauma in a War Setting: Insights from a Military Hospital in Yemen

Purpose: Duodenal injuries are a significant challenge in war trauma because of their complexity and potential for severe complications. This study evaluated the outcomes of duodenal injury management among patients with war trauma in Yemen, focusing on incidence, severity, surgical approaches, postoperative complications, and factors influencing success or failure. Patients and Methods: A retrospective analysis was conducted on 520 exploratory laparotomy cases from June 2019 to December 2022 at a military hospital in Yemen. Twenty-seven patients with confirmed duodenal injuries were included. Data on demographic characteristics, injury characteristics, surgical management, and outcomes were collected and analyzed. Results: The incidence rate of duodenal injuries was 5.2%. The cohort comprised predominantly young males, with a mean age of 21.93 years. Penetrating trauma accounted for 95.7% of cases. The mean Injury Severity Score (ISS) was 20.63, and most injuries were classified as AAST Grade II. The second duodenum part (D2) was the most commonly affected area. Associated injuries were frequent, particularly colonic (73.9%), chest (39.1%), and liver (29.6%) injuries. Surgical management primarily involved exploratory laparotomy (81.5%) and primary closure (66.7%). Postoperative complications were common, affecting 66.7% of patients, with sepsis (55.6%) being the most common. The success and mortality rates were 81.5%, and the mortality rate was 11.1%. Key risk factors for poor outcomes included higher ISS, grade III injury, damage control surgery, and shrapnel injury. Conclusion: Duodenal injuries in war trauma settings pose significant management challenges, with high rates of associated injuries and postoperative complications. Early diagnosis, appropriate surgical techniques, and vigilant postoperative care is crucial for improved outcomes. Further multicenter research is needed to validate these findings and enhance management strategies in diverse settings.