Background: Access to the 4th part of the duodenum in the region of the ligament of Treitz can be very difficult. Primary repair or traditional duodenal diverticulization is often technically challenging for managing trauma at this location. Due to the frequent concomitant injuries and hemorrhage, a quick, simple and safe repair technique is highly desirable. Methods: 3 patients with penetrating injuries to the 4th part of the duodenum were managed by a technique affording good exposure, and involving linear stapling across the bowel proximal and distal to the site of injury, with a jejuno-duodenal anastomosis to the 2nd part of the duodenum, the proximal jejunum having been delivered through a window fashioned in the transverse mesocolon. Results: All patients survived and suffered no complications of their duodenal repair. Conclusions: The technique described offers a relatively simple, apparently safe and effective approach to a difficult problem in trauma surgery.

Duodenojejunal injuries region at the angle of Treitz are rare, variable etiology and often associated with other serious injuries. In trauma situations with perforations and bleeding, his approach is often difficult. The primary suture, resection / anastomosis and duodenal exclusion are the usual for trauma management techniques in this region. The aim of this paper is to show the initial results of an alternative for injuries duodenojejunal angle (IDJA) by filling a retrospective, descriptive and observational technique, 12 patients operated were analyzed over a period of 15 years, carriers IDJA, age: 34, 11 gunshot wound. 92% of the cases had other associated visceral injuries. The average for the ISS was 29. In all cases located in duodenum duodenojejunoanastomosis II, via the right lateromesenterica upon closing section and duodenum level III was performed. 58% of cases were complicated. Mortality case series were 1 (8%) digestive suture failure colon. Average Hospital stay 26 days. Conclusion: A simple, safe and maintaining gut physiology is proposed technique; with a single anastomosis, located in well-vascularized area and away from bruising and contaminated areas. The complications were pancreatic fistula and digestive suture failure.