Traumatic lesions of the duodenum

Injuries of the duodenum are relatively uncommon on account of the organ's size and position. Since most of it is retroperitoneal, lesions involving it give rise to such subtle physical and radiological signs that the diagnosis is often overlooked in the early phase after injury. Twenty-six cases of duodenal injury are reviewed, 18 of which were due to penetrating wounds and the remaining 8 to blunt trauma. Anterior penetrating wounds were usually associated with other intraperitoneal lesions which caused more obvious physical signs and thus drew attention to the necessity for exploration. On the other hand, both blunt trauma and posterior stab wounds frequently caused isolated retroperitoneal duodenal lesions where the diagnosis was not evident on admission, but in which the insidious and progressive development of symptoms and signs drew attention to the need for laparotomy. Early repair combined with drainage of the retroperitoneal space resulted in a good result in 23 of 26 cases, 4 of whom, however, developed a temporary lateral duodenal fistula. Two of the 3 deaths were in patients who presented late and had associated pancreatic injuries while the third was due to an abdominal vascular injury.