Comments on surgical management of penetrating duodenal injuries

ABSTRACT

Duodenal injury is one of the most serious a otherwise it may result in lethal complications. Is to apply simplified guidelines for the surgical management of duodenal injuries so that it might reduce the incidence of morbidity and mortality. During the last three years, nine patients with duodenal fistula as a result of penetrating duodenal injury were referred to Gastrointestinal and Hepatology Teaching Hospital, all these patients were reviewed to determine the severity of the duodenal injury according to the Organ Injury Scale and to discuss the surgical procedure which was performed. The recommended operative management for grades I and II duodenal injury is simple primary repair, for grade III is pyloric exclusion or jejunal serosal patch, for grade IV is duodenal diverticulization, and for grade V is Whipple's operation. In addition to that damage control surgery can be applied in certain circumstances. The simple primary repair is not sufficient treatment of moderate to severe duodenal laceration and the surgeons should adopt more advanced