Complex pancreaticoduodenal injury

Duodenal combined with the head of pancreatic injury (duodenal AAST grade 4 - 5) has incidence of 1 - 5% of all abdominal injury. Most (90%) of this injury is associated with other abdominal injuries. This type of injury is always difficult to diagnose because duodenum and head of the pancreas are located in retroperitoneal space, clinical presentation usually subtle and intraoperative finding may obscure. Computed tomography (CT) of the abdomen is a useful diagnostic tool. Debridement and primary repair with external drainage of the injured site is the mainstay treatment of this condition. An adjunct procedure can be combine with the primary repair to increase the chance of healing. A variety of adjunct procedures have been reported such as duodenal diverticulization, triple tube approach, pyloric exclusion with gastrojejunostomy, and pancreatoduodenectomy; these procedures have high mortality and complication rate. Current studies suggested reducing adjunct procedures to decrease morbidity and mortality.