Duodenum
•Primary repair +/- gastro-enterostomy
•Roux limb
•Jejunal serosal patch
•Damage control oversew with catheter duodenostomy, diversion of stomach by stapling across D1 without division and gastrojejunostomy (+/- T tube drainage for associated CBD injury as a ?Hugh-Devine type procedure)
Pancreas
•With Lucas grade III injuries or extensive damage to the pancreatic head, perform debridement as a damage control procedure or Whipple if well.
•With Lucas grade II, debride/drain (usual for grade I), a roux-en-y longitudinal pancreaticojejunostomy or distal pancreatectomy
Sunday, September 30, 2007
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