/

Table of contents

Expand All Topics

Duodenal trauma

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of duodenal trauma are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2019).
1

Diagnostic investigations

Ultrasound
As per AAST/WSES 2019 guidelines:
Obtain eFAST for detecting free fluid and solid organ injury.
A
Do not obtain routine ultrasound for the diagnosis of duodeno-pancreatic trauma. Consider obtaining contrast-enhanced ultrasound in stable patients with trauma with suspected pancreatic injury.
D
Create free account

More topics in this section

  • CT

  • Abdominal radiography

Diagnostic procedures

Peritoneal lavage: as per AAST/WSES 2019 guidelines, recognize that diagnostic peritoneal lavage does not improve the specificity of diagnosing duodeno-pancreatic injury, and it is sensitive but not specific for biliary tract injury.
B

Medical management

Nonoperative management: as per AAST/WSES 2019 guidelines, use hemodynamic stability as the key factor in determining management strategy in patients with duodenal injury.
B
Show 4 more

Surgical interventions

Exploratory laparotomy: as per AAST/WSES 2019 guidelines, perform exploratory laparotomy in hemodynamically unstable (WSES class IV) patients with a positive eFAST.
A
Show 2 more

More topics in this section

  • Indications for surgery

Specific circumstances

Pediatric patients
As per AAST/WSES 2019 guidelines:
Manage pediatric patients with duodenal-pancreatic trauma by specialists with specific skills and only in trauma centers.
B
Obtain ultrasound with or without contrast enhancement as the diagnostic modality of choice for follow-up imaging in pediatric patients. Prefer MRI if cross-sectional imaging is required.
B

More topics in this section

  • Pregnant patients

  • Patients with pancreatic injury (evaluation)

  • Patients with pancreatic injury (nonoperative management)

  • Patients with pancreatic injury (operative management)

Follow-up and surveillance

Clinical follow-up: as per AAST/WSES 2019 guidelines, perform serial clinical examination during follow-up after biliary and pancreatic-duodenal trauma.
B

More topics in this section

  • Imaging follow-up