Resection of the angle of Treitz and distal diverticulization of the duodenum in penetrating abdominal injuries.

BACKGROUND

Access to the 4th part of the duodenum in the region of the ligament of Treitz can be very difficult. Primary repair or traditional duodenal diverticulization is often technically challenging for managing trauma at this location. Due to the frequent concomitant injuries and hemorrhage, a quick, simple and safe repair technique is highly desirable.

METHODS

3 patients with penetrating injuries to the 4th part of the duodenum were managed by a technique affording good exposure, and involving linear stapling across the bowel proximal and distal to the site of injury, with a jejuno-duodenal anastomosis to the 2nd part of the duodenum, the proximal jejunum having been delivered through a window fashioned in the transverse mesocolon.

RESULTS

All patients survived and suffered no complications of their duodenal repair.

CONCLUSIONS

The technique described offers a relatively simple, apparently safe and effective approach to a difficult problem in trauma surgery.