Severe duodenal injuries. Treatment with pyloric exclusion and gastrojejunostomy

Arch Surg. 1983 May;118(5):631-5. doi: 10.1001/archsurg.1983.01390050097019.


During a 12-year period, 313 patients with duodenal injuries were treated. Primary repair, pyloric exclusion, and gastrojejunostomy were used in 128 patients (41%) with severe duodenal and pancreaticoduodenal injuries, to reduce "duodenal" morbidity and mortality. The duodenal fistula rate was 2.2% overall, and 5.5% in the patients undergoing exclusion. Only two deaths were due to fistulas. Forty-two patients underwent upper gastrointestinal tract examinations after operation. In patients examined 21 days or more after operation, 94% had a patent pylorus. Marginal ulceration was infrequent (four patients), as were complications associated with the procedure (3%). Pyloric exclusion with gastrojejunostomy is a quick and simple procedure that allows return of pyloric patency and is associated with a low incidence of duodenal fistulas. When fistulas do develop, they are usually easily controlled and are associated with a low mortality. We believe pyloric exclusion with gastrojejunostomy to be the procedure of choice in patients with severe duodenal and pancreaticoduodenal trauma.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Duodenum / injuries
  • Duodenum / surgery*
  • Female
  • Humans
  • Jejunum / surgery*
  • Male
  • Middle Aged
  • Pylorus / surgery*
  • Wounds and Injuries / mortality
  • Wounds and Injuries / surgery*