ABSTRACT
Although pancreaticoduodenal injuries are uncommon, occurring in less than 0.5% of trauma patients, they can be associated with significant morbidity and mortality. Determinants of morbidity and mortality include the severity of the pancreaticoduodenal injuries, Injury Severity Score (ISS), concomitant injuries to other organs, major vascular injury, and shock on presentation. The organ injury scaling systems of the American Association for the Surgery of Trauma (AAST) are widely used in the published literature describing these injuries. Duodenal leaks occur in a substantial minority (8–32%) of patients after repair and are a significant source of morbidity and mortality. Available data demonstrate that primary repair of duodenal injury is safe and effective in most injuries, regardless of AAST grade or mechanism. Pyloric exclusion with or without gastrojejunostomy is still performed as an adjunctive procedure for the repair of severe duodenal injuries, but there are insufficient data to suggest that it improves outcomes or prevents complications.
