Date of Award

4-1972

Degree Type

Master's Essay - Restricted

Degree Name

Master of Science (MS)

Department

Medical

First Advisor

Edwin H. Ellison

Second Advisor

William J. Schulte

Third Advisor

Joseph C. Darin

Abstract

The management of duodenal injuries and defects remains one of the most difficult problems of intra-abdominal surgery. The duodenum lies adjacent and actually adherent to such other vital structures as the common bile duct, pancreas, inferior vena cava, aorta and superior mesenteric vessels. It is also in close approximation to the right kidney, ureter, adrenal glands and hepatic flexure of the colon. Not only is this segment of the gastrointestinal tract obliged to accept the partially digested content of the stomach, having been acted upon by hydrochloric acid and pepsin, but it is also subject to the chemical effects of bile and the powerful enzymatic effects of the pancreatic secretions. As much as 4000 cc. of chemically active substance may pass through the duodenum each day. Because of these anatomic relationships and the tremendous mechanical and chemical activity of the duodenum a large defect in its wall presents a problem peculiar to this short segment of the abdominal intestinal tract. Defects of the stomach, jejunum, ileum or colon which are too large to permit simple closure can be managed by resection and end-to-end anastomosis, or, in appropriate instances, by colon exteriorization and secondary restoration of continuity. Its retroperitoneal location and intimate anatomic associations make similar management of duodenal defects ill-advised or impossible. Furthermore, if the management is faulty or the attempted repair fails the patient's course is complicated by sepsis, fistula formation and a very high mortality rate. It is the purpose of this paper to review the methods of repair used in the past for duodenal defects and to experimentally evaluate the use of open pedicle grafts of ileum for the repair of large duodenal defects.

Comments

A Thesis Submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements For the Degree of Master of Science in Surgery, Milwaukee, Wisconsin.

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