presentation or the paucity of findings on initial imaging [55, 57]. When
present, CT scan findings of full thickness injury include extravasation of air or
contrast into the paraduodenal, pararenal, or retroperitoneal space [54].^
Complications are more common after repair of duodenal injuries than
following operative repair for any other area of the gastrointestinal tract.^50
Operative repair of duodenal injuries are tailored to the extent of the injuires.
Approaches may include a serosal patch, transverse primary repair, duodenal
diverticularization, pyloric exclusion, and gastrojejunostomy [54,57]. Full-
thickness injuries not involving the biliary or pancreatic ductal system with
healthy surrounding tissue can be repaired primarily [51].^ In patients with a
complex duodenal injury, diversion and drainage should be considered. In
these cases, a duodenostomy tube and gastrostomy may be helpful for
decompression. A feeding jejunostomy is recommended for early enteral
nutrition, and drains should be placed near the repair. Earlier diagnosis of
duodenal injuries may make the injury more amenable to primary repair.
Proximal drainage via a gastrojejunostomy and pyloric exclusion may be
warranted when there is a significant delay in diagnosis (>24 hrs), or those with
a grade III or greater injury [50].
Compartment Syndrome
Compartment syndrome occurs when the pressure within an anatomic
compartment increases to the point where tissue perfusion and celluar
oxygenation are compromised. High intercomparmental pressure initiates