Abstract
Background Duodenal injuries are rare but pose significant challenges in war trauma settings because of their complexity and associated complications. This study evaluated the incidence, anatomical distribution, surgical approaches, postoperative complications, and factors influencing the outcomes of duodenal injury management in a conflict setting in Yemen. Methods A retrospective analysis was conducted on 520 exploratory laparotomy cases from June 2019 to December 2023 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 Among the 520 exploratory laparotomy cases reviewed, 27 (5.2%) patients had confirmed duodenal injuries. The study population was predominantly young males (n = 26, 96.3%) with a mean age of 21.93 ± 4.08 years. Penetrating trauma was the leading cause of injury (n = 26, 95.7%), and the second portion of the duodenum (D2) was the most frequently affected segment (n = 12, 44.4%). Most injuries were classified as the American Association for the Surgery of Trauma (AAST) grade II (n = 26, 96.3%). Surgical management primarily involved exploratory laparotomy (n = 22, 81.5%) and primary repair (n = 18, 66.7%). Postoperative complications occurred in 70.4% (n = 19), with sepsis (n = 10, 52.6%) and chest-related complications (n = 9, 47.4%) being the most common. The short-term success rate was 81.5% (n = 22), while the mortality rate was 11.1% (n = 3). Shrapnel injuries (80% vs. 13%, p = 0.009), higher injury severity scores (27.20 ± 9.34 vs. 19.14 ± 7.80, p = 0.05), and damage control surgery (60.0% vs. 9.1%, p = 0.008) were key factors associated with poorer outcomes. Conclusion Duodenal injuries after war trauma are associated with high rates of complications and mortality. Early diagnosis, appropriate surgical approaches, and vigilant postoperative care are critical for improved outcomes. These findings highlight the importance of tailored management strategies in conflict settings and the need for further research to optimize care protocols in resource-limited environments.