Duodenal Trauma

Abstract

Duodenal trauma is rare enough to prevent most surgeons from having extensive experience with its management, but not so unusual as to be ignored. The challenges are not simply in the operative decision-making, but also in the timely diagnosis. The duodenum accounts for only 5% of intra-abdominal traumatic injuries, likely owing to its deep, mostly retroperitoneal location. Fully three-quarters of duodenal injuries reported in the world’s literature are from penetrating wounds, and nearly all (90%) will have associated intra-abdominal injuries. Hemorrhage control, halting contamination, and definitive repair of the duodenal injury are the hallmarks of good management. The grade or severity of the duodenal injury will direct the appropriate surgical repair technique. Timely diagnosis is imperative, for a delay will increase mortality four-fold. This review contains 6 figures, 2 tables, and 24 references. Key Words : Duodenum; Pylorus; Injury; Trauma; Pyloric exclusion; Amylase; Lipase; tube-duodenostomy; Whipple procedure; Retroperitoneum