Duodenal Injury

Question: Injury to the duodenum - Management?
Answer: Hematoma on CT scan = observation, NGT - if no resolution that exploration; <50% lumen laceration = primary transverse repair with omental patch;  If complete transection, primary reanastomosis first; If reanastomosis not possible and injury in the first part of the duodenum than antrectomy, vagotomy and BI or BII reconstruction, if in the 2nd half of the duodenum than roux-en-Y duodenojejunostomy

Duodenal Diverticulization = BII, decompressive duodenal tube and peri-duodenal drainage
Pyloric exclusion = repair the duodenal injury, open the stomach, sew the pylorus closed and a GJ anastomosis