Duodenal Injury Algorithm

Based on Cripps & Livingston, Duodenal Injuries: What You Need to Know (J Trauma Acute Care Surg, 2026)

1 step

A: Suspected Duodenal Injury

Start

The retroperitoneal duodenum is partly protected but hard to diagnose and expose. Exam findings lag — peritonitis may be absent. Isolated duodenal injuries are uncommon: associated pancreatic, hepatobiliary, and major vascular injuries drive morbidity and mortality, and combined duodenal-pancreatic injury predicts suture-line failure and death.

Clinical Note

AAST grade does not independently predict mortality. Outcome depends on physiology at presentation, associated injuries, and delay to diagnosis. Physiology guides strategy.