Increased Penetrating Trauma and Trauma Severity During the COVID-19 Lockdown.

The COVID-19 mandated lockdown created unintended outcomes in traumatic injury patterns and psychosocial behaviors compared to previous years during the same timeframe. The aim of this research is to describe a population of trauma patients during the past 5 years to determine particular trends in trauma patterns and trauma severity. A retrospective cohort study on all adult (≥18 years) trauma patients admitted to this ACS verified Level I trauma center in South Carolina, inclusive years 2017 to 2021. A total of 3281 adult trauma patients were included during the lockdown period across 5 years. There was an increase in penetrating injuries in 2020 compared to 2019 (9% vs 4%, P < .01). The psychosocial impacts of government-mandated lockdowns may lead to increased alcohol consumption leading to a higher degree of injury severity and morbidity markers in the trauma population.

T-tube Duodenostomy for the Difficult Duodenum.

Tube duodenostomy has been described as a useful technique in the management of difficult duodenum arising from a variety of pathologies. In addition, the use of a t-tube for the duodenostomy presents a resourceful option in the event of Malecot or other such catheter unavailability. The aim of our study is to describe the technique and outcomes associated with this approach. During a six-month period in 2020, t-tube duodenostomies were performed in three patients for duodenal stump perforation: the first case involved a patient with Roux-en-Y esophagojejunostomy anatomy; the second involved duodenal stump closure security following Billroth II gastrectomy for peptic ulcer disease; and the third involved decompression following primary closure of duodenal perforation. All duodenostomies were performed with a t-tube that was trimmed with the back wall divided and then secured via the Witzel approach. The t-tube duodenostomies were performed during the index operations of all patients. No patient required additional operations. There was no mortality. All patients were closely monitored postoperatively with duodenostomies kept in place for six weeks. One patient developed a small leak after a trial of tube clamping, which was managed with continued tube drainage and antibiotics prior to definitive removal. The mean length of stay was 20.3 days with two patients being discharged to rehab. T-tube duodenostomy is a simple technique that helps avoid the blowout of the vulnerable duodenal stump in situations of biliopancreatic limb pathology, ulcerative disease, or injury.