Injuries to the duodenum pose a diagnostic and therapeutic challenge to the surgeon. Due to the intra- and extra-peritoneal location of the duodenum, the presentation can be overt or occult, and delay in diagnosis is associated with an increased mortality rate. A range of interventions have been described and this article reviews the relevant literature, highlights the salient points and suggests a treatment algorithm.
AllenGSMooreFACoxCSJrMehallJRDukeJH (1998) Delayed diagnosis of blunt duodenal injury: an avoidable complication. Journal of the American College of Surgeons187(4): 393–399.
3.
AsensioJAPetronePRoldanGKuncirEDemetriadesD (2003) Pancreaticoduodenectomy: a rare procedure for the management of pancreaticoduodenal injuries. Journal of the American College of Surgeons197(6): 937–942.
4.
AvgerinosDVLlagunaOHLoAYVoliJLietmanIM (2009) Management of endoscopic retrograde cholangiopancreatography related duodenal perforations. Surgical Endoscopy23(4): 833–838.
5.
BallardRBBadellinoMMEynonCASpottMAStazCFBuckmanRFJr (1997) Blunt duodenal rupture: a 6-year statewide experience. The Journal of Trauma43(2): 229–232.
6.
BanieghbalBVermaakCBealeP (2008) Laparoscopic drainage of a post-traumatic intramural duodenal hematoma in a child. Journal of Laparoendosc & Advanced Surgical Techniques-Part A18(3): 469–472.
7.
BardiniRSegalinAAsolatiM (1998) Disconnection of the ampulla of Vater: a new technique for reconstruction. Hepatogastroenterology45(23): 1479–1481.
8.
BaroneJEKigongoSP (2007) Pyloric exclusion leads to a trend toward more complications, a higher pancreatic fistula rate, and a longer hospital length of stay. The Journal of Trauma63(3): 720–720.
9.
BlocksomJMTyburskiJGSohnRLWilliamsMHarveyESteffesCP (2004) Prognostic determinants in duodenal injuries. The American Surgeon70(3): 248–255.
10.
BozkurtBOzdemirBAKocerBUnalBDolapciMCengizO (2006) Operative approach in traumatic injuries of the duodenum. Acta Chirurgica Belgica106(4): 405–408.
11.
BradleyEL3rdYoungPRJrChangMCAllenJEBakerCCMeredithW (1998) Diagnosis and initial management of blunt pancreatic trauma. Annals of Surgery227(6): 861–869.
12.
BrodyJMLeightonDBMurphyBLAbbottGFVaccaroJPJagminasL (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. RadioGraphics20(6): 1525–1536.
13.
BuckJRSorensenVJFathJJHorstHMObeidFN (1992) Severe pancreatico-duodenal injuries: The effectiveness of pyloric exclusion with vagotomy. The American Surgeon58(9): 557–560.
14.
ChinneryGEMadibaTE (2010) Pancreaticoduodenal injuries: re-evaluating current management approaches. South African Journal of Surgery48(1): 10–14.
15.
CogbillTHMooreEEFelicianoDVHoytDBJurkovichGJMorrisJA (1990) Conservative management of duodenal trauma: A multicenter perspective. The Journal of Trauma30(12): 1469–1475.
16.
CruzRJrVincenziR (2010) Modified duodenal diverticulization technique for the management of duodenal fistulas. The American Journal of Surgery199(2): e29–e33.
17.
DegiannisEBoffardK (2000) Duodenal injuries. British Journal of Surgery87(11): 1473–1479.
18.
DegiannisEKrawczykowskiDVelmahosGCLevyRDSouterISaadiaR (1993) Pyloric exclusion in severe penetrating injuries of the duodenum. World Journal of Surgery17(6): 751–754.
19.
DesaiKMDorwardIGMinkesRKDillonPA (2003) Blunt duodenal injuries in children. The Journal of Trauma54(4): 640–645.
20.
DuBoseJInabaKTeixeiraPG. (2008) Pyloric exclusion in the treatment of severe duodenal injuries: results from the National Trauma Data Bank. The American Surgeon74(10): 925–929.
21.
FelicianoDVMartinTDCrusePAGrahamJMBurchJMMattoxKL (1987) Management of combined pancreatoduodenal injuries. Annals of Surgery205(6): 673–680.
22.
FreyCFWardellJW (1993) Injuries to the pancreas. In: TredeMCarterDC (eds). Surgery of the PancreasEdinburgh: Churchill Livingstone, 565–589.
23.
GainesBAShultzBSMorrisonKFordHR (2004) Duodenal injuries in children: Beware of child abuse. Journal of Pediatric Surgery39(4): 600–602.
24.
GinzburgECarrilloEHSosaJLHertzJNirIMartinLC (1997) Pyloric exclusion in the management of duodenal trauma: Is concomitant gastrojejunostomy necessary?. The American Surgeon63(11): 964–966.
25.
GirginSGedikEYağmurYUysalEBaçB (2009) Management of duodenal injury: Our experience and the value of tube duodenostomy. Ulusal Travma Ve Acil Cerrahi Dergisi15(5): 467–472.
26.
GlancyK (1989) Review of pancreatic trauma. Western Journal of Medicine151(1): 45–51.
27.
HanJHHongSIKimHSRyuBYKimHK (2009) Multilevel duodenal injury after blunt trauma. Journal of the Korean Surgical Society77(4): 282–286.
28.
HasegawaTMikiYYoshiokaYMizutaniSSasakiTSumimuraJ (1997) Laparoscopic diagnosis of blunt abdominal trauma in children. Pediatric Surgery International12(2-3): 132–136.
29.
HirschbergAMMattoxKL (2006) Top Knife: The Art and Craft of Trauma SurgeryHarley, Shropshire, UK: tfm Publishing Ltd.
30.
HosseiniSAbbasiHRRezvaniHVaseiMAshrafMJ (2009) Comparison between gallbladder serosal and mucosal patch in duodenal injuries repair in dogs. Journal of Investigative Surgery22(2): 148–153.
31.
HuertaSBuiTPorralDLushSCinatM (2005) Predictors of morbidity and mortality in patients with traumatic duodenal injuries. The American Surgeon71(9): 763–767.
32.
IsikBYilmazSKirimliogluVSogutluGYilmazMKatzD (2007) A life-saving but inadequately discussed procedure: Tube duodenostomy. Known and unknown aspects. World Journal of Surgery31(8): 1616–1624.
33.
IuchtmanMSteinerTFaiermanTBreitgandABartalG (2006) Post-traumatic intramural duodenal hematoma in children. Israel Medical Association Journal8(2): 95–97.
34.
IvaturyRRNallathambiMGaudinoJRohmanMStahlWM (1985) Penetrating duodenal injuries. Analysis of 100 consecutive cases. Annals of Surgery202(2): 153–158.
35.
JansenMDu ToitDFWarrenBL (2002) Duodenal injuries: Surgical management adapted to circumstances. Injury – International Journal of the Care of the Injured33(7): 611–615.
36.
JonesR (1978) Management of pancreatic trauma. Annals of Surgery187(5): 555–562.
37.
JurczakFKahnXLetessierEPlattnerVHélouryYLe NéelJC (1999) Severe pancreaticoduodenal injuries: Review series of 30 patients. Annales De Chirurgie53(4): 267–272.
38.
KashukJLMooreEE (2007) Should pyloric exclusion for duodenal and pancreatico-duodenal injuries be abandoned?. The Journal of Trauma63(2): 452–453.
39.
KashukJLMooreEECogbillTH (1982) Management of the intermediate severity duodenal injury. Surgery92(4): 758–764.
40.
LaddAPWestKWRouseTMSchererLR3rdRescorlaFJEngumSA (2002) Surgical management of duodenal injuries in children. Surgery132(4): 748–752.
41.
LaiCHLauWY (2008) Management of endoscopic retrograde cholangiopancreatography-related perforation. Surgeon6(1): 45–48.
42.
LeppaniemiA (2007) Management of pancreatic and duodenal injuries. Lietuvos Chirurgija5(2): 102–107.
43.
LevisonMAPetersenSRSheldonGFTrunkeyDD (1984) Duodenal trauma: Experience of a trauma center. The Journal of Trauma24(6): 475–480.
44.
LinsenmaierUWurthSReiserMKornerM (2008) Diagnosis and classification of pancreatic and duodenal injurie sin emergency radiology. Radiographics28(6): 1591–1602.
45.
LloydGMSuttonCDMarshallLJJamesonJS (2004) Case of duodenal hameatoma treated with ultrasound guided drainage. ANZ Journal of Surgery74(6): 500–501.
46.
LucasCLedgerwoodAM (1975) Factors influencing outcome after blunt duodenal injury. The Journal of Trauma15(10): 839–846.
47.
MaemuraTYamaguchiYYukiokaTMatsudaHShimazakiS (1999) Laparoscopic drainage of an intramural duodenal hematoma. Journal of Gastroenterology34(1): 119–122.
48.
MangiavillanoBViaggiPMasciE (2010) Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: A literature review. Journal of Digestive Diseases11(1): 12–18.
49.
MaoZZhuQWuWWangMLiJLuA (2008) Duodenal perforations after endoscopic retrograde cholangiopancreatography: Experience and management. Journal of Laparoendosc & Advanced Surgical Techniques – Part A18(5): 691–695.
50.
MartinLW (1989) Managing a 13-year-old boy with blunt abdominal trauma. Surgery105(3): 455–456.
51.
MartinTDFelicianoDVMattoxKLJordanGLJr (1983) Severe duodenal injuries. Treatment with pyloric exclusion and gastrojejunostomy. Archives of Surgery118(5): 631–635.
52.
McInnisWDAustJBCruzABRootHD (1975) Traumatic injuries of the duodenum: A comparison of 1 degrees closure and the jejunal patch. The Journal of Trauma15(10): 847–853.
53.
McKenneyKLNuñezDBJrMcKenneyMGAsherJZelnickKShipshakD (1998) Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients. AJR American Journal of Roentgenology170(4): 979–985.
54.
MercheaACullinaneDCSawyerMDIqbalCWBaronTHWigleD (2010) Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery148(4): 876–880.
55.
MutignaniMIacopiniFDokasSLarghiAFamiliariPTringaliA (2006) Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue. Gastrointestinal Endoscopy63(4): 725–727.
56.
NassouraZEIvaturyRRSimonRJKihtirTStahlWM (1994) A prospective reappraisal of primary repair of penetrating duodenal injuries. The American Surgeon60(1): 35–39.
57.
NavsariaP (2007) Comment on Seamon MJ, Pieri PG, Fisher CA et al. ‘A ten-year retrospective review: Does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries?The Journal of Trauma62(4):829-833’. The Journal of Trauma 63(2):45.
58.
NikeghbalianSAtefiSKazemiKJalaeianHRoshanNNaderiN (2008) Repairing large duodenal injuries in dogs by expanded polytetrafluoroethylene patch. Journal of Surgical Research144(1): 17–21.
59.
OzgonulACeceHSogutODemirDKurkcuoglusIC (2010) Pneumoperitoneum, pneumoretroperitoneum and bilateral pneumothorax caused by ERCP. Journal of the Pakistan Medical Association60(1): 60–61.
60.
PalaniveluCJategaonkarPARangarajanMAnandNVSenthilnathanP (2008) Laparoscopic management of a retroperitoneal duodenal perforation following ERCP for periampullary cancer. Journal of the Society of Laproendoscopic Surgeons12(4): 399–402.
61.
PlancqMCVillamizarJRicardJCanarelliJP (2000) Management of pancreatic and duodenal injuries in pediatric patients. Pediatric Surgery International16(1-2): 35–39.
62.
RathoreMAAndrabiSINajfiSMChaudhryZChaudhryAM (2007) Injuries to the duodenum--prognosis correlates with body Injury Severity Score: A prospective study. International Journal of Surgery5(6): 388–393.
63.
RickardMJBrohiKBautzPC (2005) Pancreatic and duodenal injuries: keep it simple. ANZ Journal of Surgery75(7): 581–586.
64.
RobbsJVMacintyreIM (1980) Pancreatic and duodenal injuries. Journal of The Royal College of Surgeons of Edinburgh25: 110–116.
65.
Ruiz-TovarJLoboESanjuanbenitoAMartínez-MolinaE (2009) Case series: pneumoretroperitoneum secondary to duodenal perforation after endoscopic retrograde cholangiopancreatography. Canadian Journal of Surgery52(1): 68–69.
66.
SandeepJPTJoshiMASandhyaP (2007) Isolated pancreatic injury following blunt abdominal trauma in a child. Indian Journal of Critical Care Medicine11(2): 96–98.
SeamonMJPieriPGFisherCAGaughanJSantoraTAPathakAS (2007) A ten-year retrospective review: does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries?. The Journal of Trauma62(4): 829–833.
69.
ShankarKRLloydDAKitteringhamLCartyHM (1999) Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children. British Journal of Surgery86(8): 1073–1077.
70.
SriussadapornSPak-artRSriussadapornSKritayakiranaK (2004) Management of blunt duodenal injuries. Journal of The Medical Association of Thailand87(11): 1336–1342.
71.
TalvingPNicolAJNavsariaPH (2006) Civilian duodenal gunshot wounds: surgical management made simpler. World Journal of Surgery30(4): 488–494.
72.
ThomasMBasuNNGulatiMSSeagerROkeTConstantinescuG (2009) Isolated duodenal rupture due to go-karting accidents--braking news. The Annals of The Royal College of Surgeons of England91(4): 340–343.
73.
TimaranCHDaleyBJEndersonBL (2001) Role of duodenography in the diagnosis of blunt duodenal injuries. The Journal of Trauma51(4): 648–651.
74.
TimaranCMartinezOOspinaJA (1999) Prognostic factors and management of civilian penetrating duodenal trauma. The Journal of Trauma47(2): 330–335.
75.
TytgatSHZwavelingSKramerWLvan der ZeeDC (2010) Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma. Injury00: epub ahead of print (accessed 19 June 2011).
76.
VaughanGD3rdFrazierOHGrahamDYMattoxKLPetmeckyFFJordanGLJr (1977) The use of pyloric exclusion in the management of severe duodenal injuries. The American Journal of Surgery134(6): 785–790.
77.
VelmahosGConstantinouCKasotakisG (2008) Safety of repair for severe duodenal injuries. World Journal of Surgery32(1): 7–12.
78.
VelmahosGCKamelEChanLSHanpeterDAsensioJAMurrayJA (1999) Complex repair for the management of duodenal injuries. The American Journal of Surgery65(10): 972–975.
79.
VossMBassDH (1994) Traumatic duodenal haematoma in children. Injury25(4): 227–230.
80.
WigJDKudariAYadavTDDoleyRPBharathyKGSKalraN (2009) Pancreas preserving total duodenectomy for complex duodenal injury. Journal of the Pancreas10(4): 425–428.
81.
ZissinROsadchyAShapiro-FeinbergMGayerG (2003) CT of a thickened-wall gall bladder. The British Journal of Radiology76(902): 137–143.