الفهرس 
ANATOMY OF THE DUODENUMOnly 14 pages are availabe for public view
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Abstract
D
SUMMARY
uodenum may perforate due to traumatic or non traumatic causes. Traumatic perforation may be due to blunt injury: civil violence, road traffic or motor car accidents, seat belt injury, or penetrating injury: gunshot, knife, within few hours.
Iatrogenic injury e.g. during ERCP, nephrostomy, open or laparoscopic operation. Non traumatic perforation may be due to perforated peptic ulcer, perforated diverticulum.
There is significant difference between adults and children duodenal perforation e.g. blunt injuries and haematoma are more common in children, healing of duodenal injuries is better in children than in adults, and thus simple repair can be done in children with more encouraging outcome than adults.
Due to the retroperitoneal site of duodenum, the clinical diagnosis is difficult unless a high index of suspicion is maintained.Initial physical examination is usually generally negative and diagnostic delay is common. Midepigastic pain is the most common symptoms followed by signs of chemical peritonitis within few hours.
CT scan with both oral and intravenous contrast medium is of paramount importance and the development of multi detector-row CT has improved the ability to examine and detect duodenal injuries.
Patients with low grade duodenal injuries, simple repair is adequate, patients with severe duodenal injuries may require more sophisticated repair if suture wound dehiscence is expected.
There are new protocols for management of duodenal perforations post duodenal ulcer and ERCP, also laparoscopic repair of duodenal is a trend that can be done concerning many cases of duodenal perforation under certain conditions.
Conservative management of selected cases of duodenal perforation can be chosen but many precautions must be thought of and close observation is highly important.