title: Management of descending duodenal injuries secondary to laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To report our experience of managing patients affected by descending duodenal injuries secondary to laparoscopic cholecystectomy and to review the literature.
  
  
  METHODS
  Analysis of 5 cases of descending duodenal injury as a consequence of laparoscopic cholecystectomy managed between June 1992 and September 2006.
  
  
  RESULTS
  The median age was 59 (range 49-67) years. In all cases an emergency laparotomy showed an injury to the descending duodenum. 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.
  
  
  CONCLUSIONS
  Descending duodenal injuries are extremely rare complications 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.
authors.affiliation: Section of General and Thoracic Surgery, Department of Applications in Surgery of Innovative Technologies, University Medical School, Bari, Italy. mario.testini@tin.it
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Piccinni
authors.forename: Germana
authors.initials: G
authors.lastname: Lissidini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Di Venere
authors.forename: Angela
authors.initials: A
authors.lastname: Gurrado
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poli
authors.forename: Nicola
authors.initials: N
authors.lastname: Brienza
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.forename: Michele
authors.initials: M
authors.lastname: Nacchiero
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000601:surgery*; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004386:Duodenum / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged