Article Figures & Data
- Figure 1
CT of the abdomen demonstrating multiple foreign bodies in the duodenum and proximal small bowel, with evidence of perforation.
- Figure 2
Intraoperative evidence of perforated D4 segment of the duodenum due to foreign body (toothbrush).
- Table 1
Summary of AAST Organ Injury Scale for the duodenum and associated WTA management recommendations
AAST organ injury scale for duodenum Grade Description WTA recommended management I Hematoma involving a single portion of the duodenum Initial non-operative management.
If non-resolving, drainage and simple repair.
Partial thickness laceration without perforation Simple repair.
II Hematoma involving >1 portion of the duodenum Same as grade I hematoma.
Laceration <50% of circumference Simple, tension-free repair, preferably transverse.
If A not possible, see grade III.
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).
IV Laceration >75% of circumference Same as grade III.
Laceration >75% of circumference, involving ampulla or distal CBD Complex reconstruction with Roux-en-Y limb or pancreaticoduodenectomy.
V Massive destruction of duodenopancreatic complex or duodenal devascularization Complex reconstruction with Roux-en-Y limb or pancreaticoduodenectomy.
Adapted from Malhotra et al.2
AAST, American Association for the Surgery of Trauma; CBD, common bile duct; WTA, Western Trauma Association.
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