Management of descending duodenal injuries secondary to laparoscopic cholecystectomy

Aim: To report our experience of managing patients affect- ed by descending duodenal injuries secondary to laparo- scopic cholecystectomy and to review the literature. Meth- ods: Analysis of 5 cases of descending duodenal injury as a consequence of laparoscopic cholecystectomy managed between June 1992 and September 2006. Results: The me- dian age was 59 (range 49–67) years. In all cases an emer- gency laparotomy showed an injury to the descending duo- denum. Two patients underwent direct suture of the duodenum and external biliary drainage through a T-tube, 1 case underwent a duodenojejunostomy and in another a duodenopancreatectomy. The latter patient underwent drainage of the duodenum with a Petzer tube, followed 5 days later by gastric resection, closure of the duodenal stump and repair of the duodenal wound by suture. The median postoperative stay was 45 days and 1 patient died. Conclu- sion: Descending duodenal injuries are extremely rare com- plications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. The site of the descending duodenal injury is important for determining the surgical approach.