Isolated and Combined Duodenal and Pancreatic Injuries: A Review and Update

Duodenal and pancreatic injuries are challenging to diagnose and treat. Over the last several decades, appropriate and optimal surgical management of these injuries have been debated. This is a review of the latest literature regarding diagnosis and operative management of these injuries. In duodenal injury, primary repair should be pursued for partial or complete transection with little tissue loss and no ampulla involvement. In more complex injuries, where tension-free repair is not possible, Roux-en-Y duodenojejunostomy or pyloric exclusion with diverting gastrojejunostomy can be utilized. Wide external closed suction drainage is recommended for grade I, II, and IV pancreatic injuries. Distal pancreatectomy with or without splenectomy is recommended for grade III injuries. Pancreatoduodenectomy in a staged procedure is safe for grade V combined injuries with ductal disruption. Delayed diagnosis contributes to increased mortality in pancreatic and duodenal trauma. Establishing early diagnosis and ductal involvement followed by appropriate surgical intervention improves outcomes.