Effective Management of Traumatic Duodenal Transection Using Primary Closure, Triple Tube Decompression, and Omental Patch: A Case Report

Duodenal injuries are rare, comprising approximately 3–5% of abdominal traumas, and are often accompanied by other organ injuries due to the duodenum's retroperitoneal location. Their diagnosis can be challenging, frequently resulting in delays that increase morbidity and mortality. A significant complication is anastomotic leakage post-repair, primarily due to the duodenum's exposure to substantial volumes of gastric, biliary, and pancreatic secretions. These factors necessitate prompt recognition and appropriate surgical intervention to improve patient outcomes [1]. Berne’s duodenal diverticulization, introduced in 1968, is a surgical technique designed to manage complex duodenal and pancreatic injuries. It involves closure of the duodenal injury, gastric antrectomy with end-to-side Bill Roth II gastrojejunostomy, tube duodenostomy, and abdominal drainage to divert gastrointestinal contents and protect the repair site [2], Pyloric exclusion [3], reverse tube duodenostomies [4] as a protection for primary repair. In this case report, we present an isolated traumatic duodenal injury managed with primary repair, triple tube decompression, and an innovative omental patch technique. This approach effectively protected the duodenal suture line and facilitated healing. Similar strategies have been employed in paediatric cases, such as a 10-year-old boy with a complete duodenal transection, who underwent primary closure with omental reinforcement and triple tube decompression, resulting in an uneventful recovery.