Copyright © Hisham Bahmad Mohammad Al-Karsify 1,2 , Hussein Abou-Abbass 1 , Fadi Iskandarani 3 and Hisham Bahmad 1,4 * 1 Faculty of Medicine, Beirut Arab University, Lebanon 2 Department of General Surgery, Rafik Hariri University Hospital, Lebanon 3 Pediatric Surgery Division, Rafik Hariri University Hospital, Lebanon 4 Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon *Corresponding author: Hisham Bahmad, MD, MSc, Research Fellow, Faculty of Medicine, American University of Beirut, Beirut-Lebanon Submission: April 20, 2018; Published: May 23, 2018 “Triple-Tube-Ostomy” Technique for Management of Duodenal Injuries: A Systematic Review and Meta-Analysis Introduction In contrast to the liver and spleen, injuries to the duodenum are much less frequent, reported as 0.2% of blunt trauma injuries [1,2], and comprising 0.2–3.7% of all trauma-related laparotomies [3]. What makes isolated duodenal injuries scarce is the fact that duodenal trauma is usually associated with one to four other abdominal organ injuries [2,4]. Furthermore, due to its anatomical position, the “protected” retroperitoneal location of the duodenum limits the chance of injury but makes early diagnosis and treatment a difficult task [5,6]. Add to this diagnostic dilemma is the frequency of associated intra-abdominal and/or multisystem injuries such as concomitant injuries that affect the liver in about 17%, pancreases, colon and small bowels each in about 11% [7,8], which can mask subtle physical and radiographic diagnostic signs found in isolated blunt injuries to the duodenum [9]. Hence, diagnosis is challenging, particularly in the setting of acute blunt trauma, since symptoms and signs resulting from these injuries may not be obvious. Case Report Research in Pediatrics & Neonatology C CRIMSON PUBLISHERS Wings to the Research 125 Copyright © All rights are reserved by Eileen R McGrath. Volume 2 - Issue - 2 ISSN: 2576-9200 Abstract Background: Isolated duodenal injury following blunt or penetrating trauma remains an extremely rare and one of the most challenging hitches confronting trauma surgeons. Triple-tube-ostomy (TTO) technique involving gastrostomy, reverse duodenostomy, and feeding jejunostomy tubes insertion has shown promising results during conservative management of duodenal injuries. Objective: We aim through this paper to report a successfully managed case of isolated incomplete transverse duodenal injury managed by TTO technique in a 14-year-old boy who presented with severe abdominal pain, one day after sustaining ablunt abdominal trauma due to fall from height. In addition, we aimed to systematically review the literature for the usage and outcomes of the TTO surgical procedure, and evaluate its efficiency and effectiveness in the management of duodenal injuries. Data Sources: OVID/Medline, PubMed, and Scopus databases were lastly searched on December 8th, 2016 to identify all published research studies on duodenal injuries treated by this surgical technique. Study Selection: Studies reporting cases of duodenal injuries that were managed by TTO were warranting inclusion. Data Extraction and Synthesis: Both CARE and PRISMA guidelines were followed for conduction and reporting of this study. Throughout the whole review process, two reviewers worked independently and in duplicate to screen titles, assess full texts for eligibility, and abstract data. Results: Six articles were included in this review. Sixty five cases were reported to have undergone TTO in world literature. Majority of the cases were performed after surgical repair of giant duodenal ulcers, only 2 cases were reported due to perforations following trauma. While majority of cases had uneventful recovery, complications such as wound infections and dehiscence were reported. Mean length of hospital stay was found to be 20.5 days. Mortality occurred in 3 cases. Conclusions and Relevance: The positive outcomes of our reported case and the structured evaluation of the published studies suggest effectiveness of usage of “triple-tube-ostomy” surgical procedure for management of duodenal injuries. However, further studies are needed to assess the usage of this technique in management of duodenal injuries in comparison to other classical surgical techniques. Keywords: blunt trauma, abdomen, isolated transverse duodenal transaction, transpyloric “triple-tube-ostomy” decompression, case report, systematic review