[Traumas of the duodenum]

The aim of this study is to present current management of duodenal trauma. Duodenal lesions following penetrating injuries are rare, but more serious, than those following blunt injuries. the severity is mostly due to delay in the diagnosis and associated intraabdominal injuries. Diagnosis is based on abdominal plain film, gastroduodenography, and more recently US scan and CT-scan. Surgical procedures depend on the type of lesion. In patients operated early, a duodenal wound can be treated by suture-closure with duodenal decompression tube. If suture-closure is not available, with a wound affecting proximal or distal duodenum, resection with anastomosis can be performed. In the second portion of the duodenum, the best treatment is a jejunal plasty with a Roux-en-Y loop. When there is an associated pancreatic injury, treatment depends on whether biliary or pancreatic ducts are injured, and a pancreatico-duodenectomy could be necessary. In patients operated on later, closure with duodenal exclusion by diverticulization is associated due to the high risk of leaking.