COMPLEX DUODENAL INJURIES

Duodenal injuries should be considered complex when the injury is of h igh grade in severity or when associated with extensive injury to the pancreas or distal common duct or the ampulla. Complex injuries are be st treated by ''damage control'' in hemodynamically unstable patients. In stable patients, these injuries should be managed by repair of the duodenum, appropriate resection of the pancreas, and the pyloric excl usion procedure. Rarely, pancreaticoduodenectomy is necessary.