I | Hematoma involving a single portion of the duodenum | |
Partial thickness laceration without perforation | |
II | Hematoma involving >1 portion of the duodenum | |
Laceration <50% of circumference | Simple, tension-free repair, preferably transverse. If A not possible, see grade III.
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III | Laceration 50–75% of circumference of D2 or 75–100% of circumference of D1/D3/D4 | Simple, tension-free repair, preferably transverse If A is not possible or significant, contamination/delayed management: duodenoduodenostomy. If neither A nor B is possible and injury is distal to ampulla: perform Roux-en-Y duodenojejunostomy over injury. If neither A nor B is possible and injury is proximal to ampulla: close distal duodenum and perform Roux-en-Y duodenojejunostomy to the proximal end or anterectomy with gastrojejunostomy (Billroth II).
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IV | Laceration >75% of circumference | |
Laceration >75% of circumference, involving ampulla or distal CBD | |
V | Massive destruction of duodenopancreatic complex or duodenal devascularization | |