Management of Iatrogenic Duodenal Injuries

Optimal Repair Techniques

The World Society of Emergency Surgery recommends primary 2-layer repair for all injury grades when feasible, including grades IV and V injuries, and emphasizes the importance of tension-free transverse repair after complete exposure and removal of all devitalized tissue 1
Primary repair should be performed with nasogastric tube placement for proximal decompression, as recommended by the World Society of Emergency Surgery 1

The World Society of Emergency Surgery guidelines note that duodenal diverticulization and triple tube decompression are no longer advocated for duodenal injury treatment, and that routine use of pyloric exclusion, gastrojejunostomy, or triple tube drainage should be avoided 1
Extraluminal drains should be avoided unless required for associated injuries, as their placement correlates with increased leak rates, and the World Society of Emergency Surgery emphasizes the importance of proper drain management 1

The World Society of Emergency Surgery emphasizes that late diagnosis and treatment are associated with increased morbidity and mortality, and that complication rates are significantly higher when operative management is delayed beyond 24 hours 2, 3

Contraindications to primary repair include destructive injuries with >50% disruption of bowel circumference and mesenteric devascularization with bowel ischemia, as noted by the World Society of Emergency Surgery 4
For massive disruption of the duodeno-pancreatic complex where primary repair is not possible, segmental resection with primary duodeno-duodenostomy or Roux-en-Y reconstruction may be necessary, as recommended by the World Society of Emergency Surgery 1