“The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5% 1,2. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. These associated injuries create a significant challenge towards the early diagnosis and appropriate management. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently manage via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques (duodenal diverticulization, pyloric exclusion with or without gastrojejunostomy and pancreatoduodenectomy) without significant favorable outcomes and consequential increase in the rates of mortality.”

“Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability and/or significant associated injuries then the default should be DCS. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected. To this end, we proposed an easy-to-follow the five-step algorithm for the surgical management of these injuries, which sticks to the philosophy of “Less is Better”.”

Ordoñez CA, Pet al Damage control in penetrating duodenal trauma: less is better – the sequel. Colomb Med (Cali). 2021 May 3;52(2):e4104509.