Ladd's procedure as an adjunct to treating combined traumatic duodenal and spinal injuries

Traumatic duodenal injuries are a rare and complex challenge. The surgeon facing such an injury has several options to repair this injury: primary repair with or without a serosal patch, performing a pyloric exclusion, adding a gastrostomy and/or feeding jejunostomy, and performing a gastro-enterostomy in order to bypass the duodenum. All of these options have a significant failure rate with persisting duodenal leakage and long-term morbidity. An often overlooked insult is concomitant spinal injury that may lead to a distal duodenal obstruction due to compression by the superior mesenteric artery (SMAS). This combined injury is noted when the mechanism is a high velocity blunt trauma such as seat belt injury during a motor vehicle accident. The contribution of this obstruction to the failure rate of the duodenal repair has not been addressed yet. We describe a case in which this event was foreseen and a Ladd’s procedure was added to the duodenal repair. It is our impression that avoiding SMAS may enhance the chances of a successful duodenal repair.