Duodenal injuries: surgical management adapted to circumstances.

Abstract

To evaluate the results of an evolving policy of primary repair of duodenal injuries, when considered feasible and safe, complemented by pyloric exclusion if any doubt as to the integrity of the repair existed. A prospective analysis of all patients with surgically identified duodenal injuries treated at a single institution over a 3-year period. In 30 patients studied, there were four deaths (13%) and an overall complication rate of 47%. There were 68 associated intra-abdominal injuries in 29 patients. Primary duodenorraphy was employed in 18 patients (60%), pyloric exclusion in 11 (37%) and pancreatoduodenectomy in one patient (3%). No failures of duodenal repair were recorded. Adverse results in patients with duodenal trauma are largely a reflection of frequent associated injuries and their consequences. Selective, liberal employment of pyloric exclusion, based on individualized intra-operative assessment, can minimize duodenum-related morbidity.