Management of the intermediate severity duodenal injury

The management of intermediate severity duodenal injuries remains a controversial issue. This report details our experience with 34 patients who underwent operations for duodenal trauma in the past 3 years. Seventy-two percent had penetrating injuries. Seven patients (28%) were managed with by duodenorrhaphy and Penrose drainage, nine (36%) with duodenal diversion (pyloric exclusion with gastrojejunostomy), two (8%) with resection and anastomosis, and one (4%) with pancreaticoduodenectomy. A comparison with a previous report from our institution. in 1978 discloses (1) more severe injuries in the current series, (2) more frequent use of duodenal diversion with a corresponding decreased use of tube decompression, (3) increased nutritional support, and (4) fewer complications. Based on this experience we advocate the use of duodenal diversion and needle catheter jejunostomy for intermediate severity duodenal wounds.