Recent experiences with duodenal trauma

In a 10-year period ending December 1983, 56 patients with duodenal injuries were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. Most injuries consisted of isolated duodenal lacerations or perforations (37), five patients had duodenal hematomas, and 14 patients had injuries involving the duodenum, pancreas, ampulla, and/or common bile duct. Most injuries were successfully managed with suture repair. The Whipple procedure was necessary in five cases. Overall morbidity was 39.2 per cent, but complications directly related to the duodenal injury occurred in only six patients (10.7%). Only three patients died (5.3%). Excellent results can be achieved even with extensive duodenal injuries by the use of careful debridement and primary closure. When injuries to the duodenum are associated with injury to the ampulla of Vater, the head of the pancreas, or the common bile duct, a Whipple procedure is usually necessary. It has not been necessary to employ duodenal bypass or diverticulization.