Three cases of distal urgent duodenectomies

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442 CHIRURGIA December 2024
Chirurgia
December 2024
Vol. 37 - No. 6
CASE REPORT
Three cases of distal urgent duodenectomies
Ignacio A. GEMIO DEL REY 1, 2 *, José M. GARCÍA GIL 1, Raquel A. LATORRE FRAGUA 1, 2,
Roberto de la PLAZA LLAMAS 1, 2, José M. RAMIA 3, 4, Daniel A. DÍAZ CANDELAS 1
1Department of General and Digestive Surgery, Guadalajara University Hospital, Guadalajara, Spain; 2Department of Surgery, Medical
and Social Sciences, University of Alcalá, Alcalá de Henares, Spain; 3Department of General and Digestive Surgery, Alicante University
Hospital, Alicante, Spain; 4ISABIAL (Alicante Health and Biomedical Research Institute), Alicante, Spain
*Corresponding author: Ignacio A. Gemio del Rey, Calle Donante de sangre S/N 19002 Guadalajara, Spain. E-mail: ignaciogemio87@gmail.com
ABSTRACT
Nowadays, duodenal surgery is still complex due to the great morbidity and mortality that is historically associated with. Partial duodenectomies
have been described in the literature, usually in the 3rd and 4th portions of the duodenum, with a duodenojejunal anastomosis being subsequently
performed. With this technique, good results have been reported in infrapapillary neoplasm surgery. Nevertheless, it is not easy to nd published
cases of duodenectomies performed urgently, included total and distal D3-D4 duodenectomies. A retrospective analysis has been carried out of
the total of urgent D3-D4 partial duodenectomies performed in our hospital, to present our cases. On the other hand, we carried out a systematic
review without limits in PubMed. In our department, a total of three urgent D3-D4 partial duodenectomies have been performed. In the review
carried out, 436 articles were obtained, of which two were excluded due to their language (Japanese and Russian). Furthermore, 426 articles were
excluded because they were not the object of the current study. We can conclude that the morbidity of the procedure, despite the adverse condi-
tions posed by urgent surgery, is acceptable in most cases. Urgent partial duodenectomy is an exceptionally reported procedure in the literature.
Despite the few cases, it can be a safe alternative with less morbidity and sequelae than other procedures. However, more systematic studies are
needed to consider it systematically.
(Cite this article as: Gemio del Rey IA, García Gil JM, Latorre Fragua RA, de la Plaza Llamas R, Ramia JM, Díaz Candelas DA. Three cases of distal
urgent duodenectomies. Chirurgia 2024;37:442-7. DOI: 10.23736/S0394-9508.23.05626-7)
Key words: Duodenum; Emergencies; Case report.
Chirurgia 2024 December;37(6):442-7
DOI: 10.23736/S0394-9508.23.05626-7
GEMIO DEL REY
CASES OF PARTIAL DUODENECTOMIES
© 2023 EDIZIONI MINERVA MEDICA
Online version at https://www.minervamedica.it
Nowadays, duodenal surgery is still complex due to the
great morbidity and mortality that is historically as-
sociated with. This is due to the retroperitoneal position of
the duodenum, and its close anatomical relationship with
the pancreas. Because of that, until a few years ago, that
patients with duodenal tumour pathology underwent a ce-
phalic duodenopacreatectomy (CDP) in most cases.1-5
In 1995, Chung et al.6 described the technique of Pan-
creas-sparing total duodenectomy (PSTD),2 which sig-
nicantly reduces surgical morbidity and mortality.3 This
lower rate of complications is obtained by the reduction of
the resected organs, the surgical time and the intraopera-
tive bleeding, and by avoiding a hepaticojejunostomy in a
non-dilated bile duct and a pancreatojejunal anastomosis
in a pancreas that is usually inconsistent and with a non-
dilated Wirsung.1, 2 Furthermore, this technique is much
more physiological and facilitates endoscopic follow-up.1
The main indication for this technique is familial adeno-
matous polyposis, which affects the duodenum in 70-80%
of cases.7
Partial duodenectomies have also been described,
usually in the 3rd and 4th portions of the duodenum,
with a duodenojejunal anastomosis being subsequently
performed. This even more limited technique reduces
to one the anastomoses to be performed, preserving the
pancreas and the papilla. With this technique, good re-
sults have been reported in infrapapillary neoplasm sur-
gery.1, 3, 8, 9
Nevertheless, it is not easy to nd published cases of
duodenectomies performed urgently, included total and
distal D3-D4 duodenectomies. This fact seems to be due
to the fact that it is still a procedure little performed in
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or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet le sharing systems, electronic mailing or any other means which may allow access
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CASES OF PARTIAL DUODENECTOMIES GEMIO DEL REY
Vol. 37 - No. 6 CHIRURGIA 443
In both cases, a D2-D3 duodenectomy was performed,
including the area of the previous anastomosis. We did a
side-to-side duodenojejunal anastomosis with EndoGIA
45 mm Vascular Tri-Staple™ technology 2-3 mm. In the
third case, we did an end-to-side anastomosis with a 25
mm EEA (Figure 1). The initial diagnosis was by CT.
It is also important to note that all the patients associ-
ated a high nutritional risk, with low levels of albumin and
prealbumin (Table II). Furthermore, two of the patients
presented sepsis due to fecal peritonitis.
In the search carried out, 436 articles were obtained, of
which two were excluded due to their language (Japanese
and Russian). Furthermore, 426 articles were excluded be-
cause they were not the object of the current study. Table
I shows data and results provided in the 10 articles that
publish urgent distal duodenectomies, including the two
articles provided by Paluszkiewicz et al.10 in their review,
which are the object of our study (Figure 2).
Discussion
Nowadays, partly due to the creation of hepato-pancreato-
biliary (HPB) specic surgery units, it has been possible in
some publications to reduce mortality after CDP (2-4%),
but despite this, morbidity is still high (50%) in most se-
ries1, 4, 5, 23 even though it may be underestimated.24 In the
same way, total duodenectomies present mortality below
2-5% but a morbidity that exceeds 55% (even 70% in some
routine clinical practice, which may be due to fear of pos-
sible complications that may occur in a complex anatomi-
cal area and because as a rule, this surgery concerns fragile
patients with signicant associated comorbidities.
The objective of this paper is to carry out a systematic
review of the literature on urgent D3-D4 distal duodenec-
tomies and to associate our surgical experience on this
matter.
Clinical series
A retrospective analysis has been carried out of the total
of urgent D3-D4 partial duodenectomies performed in the
Surgery Service of our hospital. The center currently in-
cludes a health area of 267,594 inhabitants according to
the Castilla-La Mancha Community Government and is
the only hospital in the province’s public health system.
The variables were extracted from the Mambrino XXI
electronic medical record. Collected data are described in
Table I, II.
The morbidity of our surgery department is collected in
a specic form and prospectively.19, 20 In addition, for this
work, all the medical and nursing clinical comments of each
patient were analyzed with a 90-day follow-up.19 It is ex-
pressed by the Clavien-Dindo Classication21 and the Com-
prehensive Complication Index (CCI),22 which have been
validated from a clinical and economic point of view.19, 20
Talking about our reinterventions, the morbidity that has
been taken into account is the one that happens when the
duodenectomy has been performed, and not the one that is
derived from the failed initial procedure, to avoid bias.
What concerns to the follow-up, we consider test per-
formed and mortality.
On the other hand, we carried out a systematic search
without limits in PubMed updated on 08/10/2023, with the
following search strategy: ((Partial) OR (Distal) OR (Sub-
total) OR (D3) OR (D4)) AND (Duoden*) AND ((Emer-
gencies) OR (Emergency Treatment) OR (Urgent)).
In our department, a total of 3 urgent D3-D4 partial duo-
denectomies have been performed. Data and results have
been collected in Table I, II. We provide an image of our
third case (Figure 1).
We should emphasize that two of our three cases were
emergency rescue duodenectomies after previous rafas,
due to the anastomosis leak that happened. For the diag-
nosis of these fact, we used an abdominal CT scan in the
rst case and in the second one, a drainage biochemistry
analysis that showed an increase in total bilirubin and am-
ylase associated with clinical and analytical deterioration.
GEMIO DEL REY
CASES OF PARTIAL DUODENECTOMIES
Figure 1.—Transmesocolic end-to-end partial urgent duodenectomy
(D3 and D4).
D: duodenum; Y: jejunum; CT: transverse colon.
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or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet le sharing systems, electronic mailing or any other means which may allow access
to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove,
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GEMIO DEL REY CASES OF PARTIAL DUODENECTOMIES
444 CHIRURGIA December 2024
(4-42%),3, 9, 23 followed by delayed gastric emptying.23
The mean hospital stay has been 10 days,23 which is sub-
stantially less than the mean CPD stay.3 Survival at 5 years
is close to 95%.23, 25 A fundamental difference with CPD
is the absence of diabetes mellitus and exocrine pancreatic
insufciency with this type of technique.3, 23
Nevertheless, the information that we nd in the lit-
erature on distal partial duodenectomies is limited to low
series), mainly due to anastomotic dehiscence and pancre-
atic stula (42%).1, 23 Because of that, for a long time, sur-
geons have tried not to performed duodenectomies.
However, more and more series of cases of programmed
total duodenectomies with good surgical results are being
published. A duodenal suture dehiscence rate of 0% to
16.2% has been described in the literature,25 although the
main postoperative complication is still pancreatic stula
Table I.— Clinical cases of urgent partial distal duodenectomies published in the literature and in our series.8, 10-18
Study Cases Age (years) Sex Etiology Type of
resection Type of
anastomosis Anastomosis location Enteral feeding Parenteral feeding Surgical time Feeding
start (days) Hospital stay (days) Morbidity Mortality
Maher et al.81 34.6±8 M Firearm injury D3-D4 EE Retrocolic - - 5.7 hours 15.4 - - It is not specied in partial
duodenectomies
2 M Firearm injury D3-D4 EE Retrocolic - - - -
3 M Firearm injury D3-D4 ES Retrocolic - - - -
4 M Firearm injury D4 SE Retrocolic - - - -
5 M Stab injury D4 SS Retrocolic - - - -
Paluszkiewicz et al.10 1 72 F duodeno-yeyunal ischemic
necrosis D3-D4 EE resorbable
polylament
- NJT Yes - 6-7 12 Urinary infection 0% at hospital discharge
2 49 F Intestinal perforation by
chicken bone D3D4 EE resorbable
polylament
-NJT Yes - 9 None 0% at hospital discharge
3 69 M Incohercible bleeding from
giant peptic ulcer D3-D4 EE resorbable
polylament
NJT Yes - 12 Surgical wound infection 0% at hospital discharge
Affan et al.11 1 67 M Aortic bypass stulization
at D3 D3-D4 - - - - - - Exitus letalis 16
day Surgical reoperation
for colon ischemic
perforation
Exitus letalis 16 day
Jarczyk et al.12 1 45 M UGB due to GIST of D3 D3 EE (PDS 3/0) - - - - - 7 None 0% after one year of follow-
up
Mahmoud et al.13 1 58 M GIST recurrence at D4 D3 SS - Jejunostomy - - - None -
Kline et al.14 1 - - Abdominal trauma - EE - - - - - - Peritonitis and
enterocutaneous stula
(non-duodenal)
Exitus letalis during hospital
admission
2 - - Abdominal trauma - EE - - - - - - - 0% at hospital discharge
3 - - Abdominal trauma - - - - - - - - Retroperitoneal abscess
due to associated
pancreatic injury
0% at hospital discharge
Cogbill15 1 - - Abdominal trauma - - - 31% of patients
(not specied)
37% of patients
(not specied)
- - - Abdominal abscess -
2 - - Abdominal trauma - - - - - - - -
3 - - Abdominal trauma - - - - - - - -
4 - - Abdominal trauma - - - - - - - -
Talving16 1 15-52 M 94.6%
F5.3% Firearm injury - EE - Jejunostomy - - - - 58% (global) -
2 Firearm injury - EE - Jejunostomy - - - - -
3 Firearm injury - EE - Jejunostomy - - - - -
Ruso et al.17 1 27 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
2 33 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
3 49 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
Jurczak et al.18 1 - - Abdominal trauma D4 - - - - - - 34 None 0% at hospital discharge
2 - - Abdominal trauma D4 - - - - - - 18 Abdominal abscess 0% at hospital discharge
Gemio et al.1 64 M Septic shock due to iatrogenic
duodenal perforation in
aortobifemoral bypass
postoperatory
D3-D4 Mechanics SS
(EndoGIA 45) Transmesocolic Jejunostomy
and enteral
supplements after
oral feeding
Yes 4 hours and 15
minutes 15 15 Clavien-Dindo: IIIa
CCI: 47.4 0% after 7 months of follow-
up
2 70 F Biliary peritonitis due to
inadvertent duodenal
perforation after Hartmann
D3-D4 Mechanics SS
(EndoGIA 45) Transmesocolic Jejunostomy
and enteral
supplements after
oral feeding
Yes 2 hours and 15
minutes 13 17 Clavien-Dindo: IIIa
CCI: 41.4 0% after 7 months of follow-
up
3 77 F Intestinal obstruction with
secondary duodenal ischemia
due to internal hernia
D3-D4 Mechanic ES
(EEA 25 mm) Transmesocolic Enteral
supplements after
oral feeding
Yes 2 hours y 15
minutes 5 17 Clavien-Dindo: II
CCI: 38.2 0% after 7 months of follow-
up
M: male; F: female; UGB: upper gastrointestinal bleeding; GIST: gastrointestinal stromal tumor; D3: third duodenum portion; D4: fourth duodenum portion; EE:
end-to-end anastomosis; ES: end-to-side anastomosis; SE: side-to-end anastomosis; SS: side-to-side anastomosis; NJT: nasojejunal tube; CCI: Comprehensive
Complication Index.
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CASES OF PARTIAL DUODENECTOMIES GEMIO DEL REY
Vol. 37 - No. 6 CHIRURGIA 445
Table I.— Clinical cases of urgent partial distal duodenectomies published in the literature and in our series.8, 10-18
Study Cases Age (years) Sex Etiology Type of
resection Type of
anastomosis Anastomosis location Enteral feeding Parenteral feeding Surgical time Feeding
start (days) Hospital stay (days) Morbidity Mortality
Maher et al.81 34.6±8 M Firearm injury D3-D4 EE Retrocolic - - 5.7 hours 15.4 - - It is not specied in partial
duodenectomies
2 M Firearm injury D3-D4 EE Retrocolic - - - -
3 M Firearm injury D3-D4 ES Retrocolic - - - -
4 M Firearm injury D4 SE Retrocolic - - - -
5 M Stab injury D4 SS Retrocolic - - - -
Paluszkiewicz et al.10 1 72 F duodeno-yeyunal ischemic
necrosis D3-D4 EE resorbable
polylament
- NJT Yes - 6-7 12 Urinary infection 0% at hospital discharge
2 49 F Intestinal perforation by
chicken bone D3D4 EE resorbable
polylament
-NJT Yes - 9 None 0% at hospital discharge
3 69 M Incohercible bleeding from
giant peptic ulcer D3-D4 EE resorbable
polylament
NJT Yes - 12 Surgical wound infection 0% at hospital discharge
Affan et al.11 1 67 M Aortic bypass stulization
at D3 D3-D4 - - - - - - Exitus letalis 16
day Surgical reoperation
for colon ischemic
perforation
Exitus letalis 16 day
Jarczyk et al.12 1 45 M UGB due to GIST of D3 D3 EE (PDS 3/0) - - - - - 7 None 0% after one year of follow-
up
Mahmoud et al.13 1 58 M GIST recurrence at D4 D3 SS - Jejunostomy - - - None -
Kline et al.14 1 - - Abdominal trauma - EE - - - - - - Peritonitis and
enterocutaneous stula
(non-duodenal)
Exitus letalis during hospital
admission
2 - - Abdominal trauma - EE - - - - - - - 0% at hospital discharge
3 - - Abdominal trauma - - - - - - - - Retroperitoneal abscess
due to associated
pancreatic injury
0% at hospital discharge
Cogbill15 1 - - Abdominal trauma - - - 31% of patients
(not specied)
37% of patients
(not specied)
- - - Abdominal abscess -
2 - - Abdominal trauma - - - - - - - -
3 - - Abdominal trauma - - - - - - - -
4 - - Abdominal trauma - - - - - - - -
Talving16 1 15-52 M 94.6%
F5.3% Firearm injury - EE - Jejunostomy - - - - 58% (global) -
2 Firearm injury - EE - Jejunostomy - - - - -
3 Firearm injury - EE - Jejunostomy - - - - -
Ruso et al.17 1 27 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
2 33 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
3 49 M Firearm injury D3-D4 - Transmesocolic - - - - - None 0% at hospital discharge
Jurczak et al.18 1 - - Abdominal trauma D4 - - - - - - 34 None 0% at hospital discharge
2 - - Abdominal trauma D4 - - - - - - 18 Abdominal abscess 0% at hospital discharge
Gemio et al.1 64 M Septic shock due to iatrogenic
duodenal perforation in
aortobifemoral bypass
postoperatory
D3-D4 Mechanics SS
(EndoGIA 45) Transmesocolic Jejunostomy
and enteral
supplements after
oral feeding
Yes 4 hours and 15
minutes 15 15 Clavien-Dindo: IIIa
CCI: 47.4 0% after 7 months of follow-
up
2 70 F Biliary peritonitis due to
inadvertent duodenal
perforation after Hartmann
D3-D4 Mechanics SS
(EndoGIA 45) Transmesocolic Jejunostomy
and enteral
supplements after
oral feeding
Yes 2 hours and 15
minutes 13 17 Clavien-Dindo: IIIa
CCI: 41.4 0% after 7 months of follow-
up
3 77 F Intestinal obstruction with
secondary duodenal ischemia
due to internal hernia
D3-D4 Mechanic ES
(EEA 25 mm) Transmesocolic Enteral
supplements after
oral feeding
Yes 2 hours y 15
minutes 5 17 Clavien-Dindo: II
CCI: 38.2 0% after 7 months of follow-
up
M: male; F: female; UGB: upper gastrointestinal bleeding; GIST: gastrointestinal stromal tumor; D3: third duodenum portion; D4: fourth duodenum portion; EE:
end-to-end anastomosis; ES: end-to-side anastomosis; SE: side-to-end anastomosis; SS: side-to-side anastomosis; NJT: nasojejunal tube; CCI: Comprehensive
Complication Index.
Furthermore, in most of them, all urgent procedures per-
formed on the duodenum (primary rafa, duodenal exclu-
sion, partial duodenectomy, CPD, etc.) are collected glob-
ally, without conducting an individualized study of mor-
bidity, mortality, surgical time, hospital stay, etc. of the pa-
tients undergoing this specic procedure. Because of that,
the information they provide is limited and, particularly in
the case of morbidity, not very objective.
numbers series.1, 3, 6, 8, 9 In general, it has important ben-
ets, such as eliminating the possibility of biliary and/or
pancreatic dehiscence, as well as a reduction in hospital
stay.1, 3, 9 A mortality rate of 3% secondary to anastomotic
dehiscence and a morbidity of 41% has been described in
the literature.1
Nonetheless, strikingly, we only found 10 articles in the
literature describing urgent partial duodenectomies.8, 10-18
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one le and print only one copy of this Article. It is not permitted to make additional copies (either sporadically
or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet le sharing systems, electronic mailing or any other means which may allow access
to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove,
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GEMIO DEL REY CASES OF PARTIAL DUODENECTOMIES
446 CHIRURGIA December 2024
rescue of previous failed rafa, obtaining a good postsur-
gical result. We can afrm that, in our series, performing
an urgent D3-D4 duodenectomy in patients with biliary
peritonitis due to previous duodenal rafa dehiscence
gets better results than the initial rafa. This may be due
to duodenal tissue deterioration and poor vascularization
of the area,10 making better the resection and anastomo-
sis in an area with more appropriate conditions, despite
the increased complexity of the surgical procedure. In our
series, we provided nutritional information and we had an
anastomotic dehiscence rate of 0%.
Likewise, the use of broad-spectrum antibiotics25 is rec-
ommended in the postoperative period while awaiting cul-
tures, as well as parenteral and later enteral nutritional sup-
port as soon as possible.10 Only 4 of the 10 published series
provide postoperative nutritional information.10, 13, 15, 16
Conclusions
Urgent partial duodenectomy is an exceptionally reported
procedure in the literature. Despite the few cases, it can
be a safe alternative with less morbidity and sequelae than
other procedures. However, more systematic studies are
needed to consider it systematically.
References
1. Spalding DR, Isla AM, Thompson JN, Williamson RC. Pancreas-spar-
ing distal duodenectomy for infrapapillary neoplasms. Ann R Coll Surg
Engl 2007;89:130–5.
2. Ramia-Ángel JM, Quiñones-Sampedro JE, de la Plaza-Llamas R, Gó-
mez-Caturla A, Veguillas P. Duodenectomía total con preservación pan-
creática. Cir Esp 2013;91:458–68.
Despite this, we can conclude that the morbidity of the
procedure, despite the adverse conditions posed by urgent
surgery, is acceptable in most cases. In our series, with its
expression using the Clavien-Dindo20 and CCI classica-
tion,21 we obtained a morbidity ranging between Clavien-
Dindo II and IIIa and CCI with a range of 38.2-37.4. These
data, in the case of an urgent surgery that affects the duo-
denum, are acceptable with respect to what has been pub-
lished previously and improve the results of more aggres-
sive surgeries such as DPC.1, 4, 5, 23
A point of special relevance in our series is that two
of the three duodenectomies were performed as surgical
Table II.— Additional data from our series.
Additional data Patient #1 Patient #2 Patient #3
Comorbidities HBP, peripheral arterial disease HBP, recent left hemicolectomy due to
left colon ADC (pT2N0)
Remission NHL
ASA II II II
Surgical data 02/27/2020 03/06/2020 05/24/2019
Diagnostic tests Abdominal CT Drainage biochemistry (Amylase 4800) Abdominal CT
Rescue surgery Yes Yes No
Previous failed surgery Primary duodenal rafa Primary duodenal rafa -
Somatostatin Yes Yes No
Starting oral feeding 15th 14th 4th
Hospital stay 15 (total 32) 17 17
Albumin 21.9 g/L preoperative 17.8 g/L preoperative 27.8 g/L preoperative
Prealbumin 8 mg/dL preoperative 5 mg/dL preoperative 4 mg/dL preoperative
Nutritional index 9 (high risk) 11 (high risk) 10 (high risk)
AP Previous rafa dehiscence + changes
due to localized ischemic necrosis
Acute perforated enteritis with
extensive deep ssures
Transmural ischemic necrosis
HBP: high blood pressure; ADC: adenocarcinoma; NHL: non-Hodgkin lymphoma; CT: computed tomography; AP: anatomical pathology.
Figure 2.—PRISMA ow diagram for the systematic review.
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one le and print only one copy of this Article. It is not permitted to make additional copies (either sporadically
or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet le sharing systems, electronic mailing or any other means which may allow access
to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove,
cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
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CASES OF PARTIAL DUODENECTOMIES GEMIO DEL REY
Vol. 37 - No. 6 CHIRURGIA 447
jury severity (OIS) and outcome. Am Surg 1994;60:500–4.
15. Cogbill TH, Moore EE, Feliciano DV, Hoyt DB, Jurkovich GJ, Mor-
ris JA, et al. Conservative management of duodenal trauma: a multicenter
perspective. J Trauma 1990;30:1469–75.
16. Talving P, Nicol AJ, Navsaria PH. Civilian duodenal gunshot wounds:
surgical management made simpler. World J Surg 2006;30:488–94.
17. Ruso L, Taruselli R, Metcalfe M, Maddern G. Resection of the angle
of Treitz and distal diverticulization of the duodenum in penetrating ab-
dominal injuries. Dig Surg 2004;21:177–80, discussion 781.
18. Jurczak F, Kahn X, Letessier E, Plattner V, Héloury Y, Le Néel JC.
[Severe pancreaticoduodenal trauma: review of a series of 30 patients].
Ann Chir 1999;53:267–72. [French].
19. de la Plaza Llamas R, Ramia Ángel JM, Bellón JM, Arteaga Per-
alta V, García Amador C, López Marcano AJ, et al. Clinical Validation
of the Comprehensive Complication Index as a Measure of Postopera-
tive Morbidity at a Surgical Department: A Prospective Study. Ann Surg
2018;268:838–44.
20. de la Plaza Llamas R, Hidalgo Vega Á, Latorre Fragua RA, López
Marcano AJ, Medina Velasco AA, Díaz Candelas DA, et al. The Cost of
Postoperative Complications and Economic Validation of the Comprehen-
sive Complication Index: prospective Study. Ann Surg 2021;273:112–20.
21. Dindo D, Demartines N, Clavien PA. Classication of surgical com-
plications: a new proposal with evaluation in a cohort of 6336 patients and
results of a survey. Ann Surg 2004;240:205–13.
22. Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The com-
prehensive complication index: a novel continuous scale to measure surgi-
cal morbidity. Ann Surg 2013;258:1–7.
23. Walsh RM, Augustin T, Aleassa EM, Simon R, El-Hayek KM, Mos-
lim MA, et al. Comparison of pancreas-sparing duodenectomy (PSD) and
pancreatoduodenectomy (PD) for the management of duodenal polyposis
syndromes. Surgery 2019;166:496–502.
24. De la Plaza Llamas R, Ramia JM. Postoperative complications in gas-
trointestinal surgery: A “hidden” basic quality indicator. World J Gastro-
enterol 2019;25:2833–8.
25. Wig JD, Kudari A, Yadav TD, Doley RP, Bharathy KG, Kalra N. Pan-
creas preserving total duodenectomy for complex duodenal injury. JOP
2009;10:425–8.
3. Mitchell WK, Thomas PF, Zaitoun AM, Brooks AJ, Lobo DN. Pan-
creas preserving distal duodenectomy: A versatile operation for a range
of infra-papillary pathologies. World J Gastroenterol 2017;23:4252–61.
4. Fernández-Cruz L, Astudillo E, Cardona V. Complicaciones de la
cirugía del cáncer de páncreas. Cir Esp 2001;69:281–8.
5. López-Domínguez J, Busquets J, Secanella L, Peláez N, Serrano
T, Fabregat J. Adenocarcinoma duodenal: resultados del tratamiento
quirúrgico de una serie unicéntrica de 27 pacientes. Cir Esp (Engl Ed)
2019;97:523–30.
6. Chung RS, Church JM, vanStolk R. Pancreas-sparing duodenectomy:
indications, surgical technique, and results. Surgery 1995;117:254–9.
7. Overman MJ, Kunitake H. Epidemiology, clinical features, and types of
small bowel neoplasms; 2023 [Internet]. available from: https://www.up-
todate.com/contents/epidemiology-clinical-features-and-types-of-small-
bowel-neoplasms/print?source=search_result&search=tumores%20intes-
tino%20delgado&selectedTitle=1~94 [cited 2023, Sep 11].
8. Maher MM, Yeo CJ, Lillemoe KD, Roberts JR, Cameron JL. Pancre-
as-sparing duodenectomy for infra-ampullary duodenal pathology. Am J
Surg 1996;171:62–7.
9. García-Molina FJ, Mateo-Vallejo F, Franco-Osorio JD, Esteban-Ra-
mos JL, Rivero-Henández I. Surgical approach for tumours of the third
and fourth part of the duodenum. Distal pancreas-sparing duodenectomy.
Int J Surg 2015;18:143–8.
10. Paluszkiewicz P, Dudek W, Lowery K, Hart CA. Pancreas sparing du-
odenectomy as an emergency procedure. World J Emerg Surg 2009;4:19.
11. Affan ET, Hong S, Qasabian RA. Complete Erosion of an Aortobi-
femoral Bypass Graft Limb into Duodenum. Ann Vasc Surg 2020;67:564.
e9–11.
12. Jarczyk G, Bereziak Ł, Jackowski M. Massive gastrointestinal bleed-
ing caused by a gastrointestinal stromal tumour of the third part of the
duodenum treated by means of emergency partial duodenal resection. Prz
Gastroenterol 2015;10:181–4.
13. Mahmoud S, Salman H, Salami M. A rare case report of locally re-
current hemorrhagic duodenal gastrointestinal stromal tumor: therapeutic
challenges and review of prognostic indicators for recurrence. J Surg Case
Rep 2020;2020:rjz365.
14. Kline G, Lucas CE, Ledgerwood AM, Saxe JM. Duodenal organ in-
Conicts of interest
The authors certify that there is no conict of interest with any nancial organization regarding the material discussed in the manuscript.
Authors’ contributions
Ignacio A. Gemio del Rey and José M. García Gil have given substantial contributions to the conception or the design of the manuscript. Raquel A. Latorre
Fragua, Roberto de la Plaza Llamas, José M. Ramia, and Daniel A. Díaz Candelas have performed data acquisition, analysis and interpretation. All authors
have participated to drafting the manuscript, Ignacio A. Gemio del Rey revised it critically. All authors read and approved the nal version of the manuscript.
History
Manuscript accepted: September 1, 2023. - Manuscript received: August 30, 2023.
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