PYLORIC EXCLUSION IN SEVERE PENETRATING INJURIES OF THE DUODENUM

The study comprises 74 patients with penetrating injuries of the duode num. Sixty-three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of th e gunshot injuries within the last few years resulted in changes in th e operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12% . When only primary repair was done, the leakage rate was 43%. We sugg est that pyloric exclusion be added to the treatment of most severe gr ade II and all grade III gunshot duodenal injuries. The adequacy of pr imary repair and pyloric exclusion in grade IV injuries requires furth er study.