“Duodenal trauma is a rare occurrence existing in 1–4.7% of all abdominal trauma. Its posterior and partially retroperitoneal location shields it from most traumatic mechanisms. Colloquially referred to as the ‘surgical soul’, its proximity to complex regional anatomy makes duodenal trauma particularly at risk for biliary, pancreatic and major vascular injury with 68–86.5% of patients sustaining an associated injury.”

“Complex duodenal trauma, categorized as AAST grades III-V are a rare occurrence but present a challenge for the general surgeon. Its partially retroperitoneal position and proximity to biliopancreatic and major vascular anatomy may require complex operative repairs. The major tenets of surgical repair include a) assessment for the need for a
damage control pathway b) external drainage c) resection of non-viable tissue, d) restoring gastrointestinal continuity, e) diversion of gastrointestinal contents, bile and pancreatic enzymes, allowing the repair to heal, and f) providing feeding access.”

Bolaji T, et al Ratnasekera A, Ferrada P. Management of the complex duodenal injury. Am J Surg. 2023 Apr;225(4):639-644.