However, based on the above, we have found injuries of the duodenum in adults as well. Almost one in three patients show signs the of obstruction as a result of a duodenal hematoma. In general, the treatment of duodenal hematoma is conservative (89 to 94%) and resolved with nasogastric decompression and parenteral nutrition (3, 6). This damage can be diagnosed by (USS) and CT scan with contrast. USS can assess duodenal integrity and associated injury, and is also useful in following hematoma absorption (4). Caution must be taken to exclude other associated injuries, because in 20% of cases, the duodenal injuries are associated with damage to the pancreas (8). Czyrko C. et al.

(11) recommend that based on radiologic documentation of persistent high-grade obstruction, as well as the clinical course, patients whose obstructions do not resolve by 10 to 14 days ought to be further investigated and operative intervention considered. If a hematoma is found during the laparotomy, it must be inspected to exclude a possible perforation. In this case, a Kocherization of duodenum is necessary for the check up to be complete. The most common surgical technique in the treatment of duodenal laceration is primary suture (3, 6). Light damages can be treated by covering affected areas with omentum, or ��jejunal patch��. Another option is primary suture of the defect with the diversion of gastric contents, which consists in pyloric exclusion and gastroenterostomy. This technique is applied in cases of serious duodenal injuries or in cases of delayed diagnosis.

Depending on the case, the additional procedure of gastric diversion can be duodenostomy and a jejunal feeding tube for post-operative enteral (4). In case of complete duodenal transection, primary suture can be performed in the following circumstances: if there is little tissue loss, in cases when the ampulla of Vater is not involved and if the lips of duodenal mucosa may be updated, and closure of the damage can be made without tension. If adequate mobilization for tension-free repair is impossible or if the damage is very close ampules and the mobilization can result in damage to the common hepatic duct, a reasonable option is primary suture with Roux-en-Y anastomos with or without duodenostomy (7).

Duodenopancreatectomy is the only option in cases when duodenal injury is associated with uncontrollable bleeding from pancreas or when duodenal injury Carfilzomib is combined with the damage of the distal part to common hepatic duct, or pancreatic duct. Nowadays, laparoscopic surgery is another option for surgeons in treatment of this injury. Tytgat SH, et al. (12) have describing the successful laparoscopic treatment of a duodenal rupture. It may be particularly beneficial for hemodynamically stable patients that sustained a focal abdominal trauma.