Management Strategies and Outcomes for Duodenal and Proximal Jejunal Injuries in Penetrating Polytrauma: A Single-Center Study

Objective: To evaluate the efficacy and safety of primary repair augmented by Witzel feeding jejunostomy for managing duodenal and proximal jejunal injuries in penetrating abdominal polytrauma at a tertiary trauma center in Pakistan. Study Design: Prospective analytical study. Place and Duration of the Study: Combined Military Hospital, Quetta, Pakistan from Aug 2023 to Jun 2025. Methodology: Patients with penetrating duodenal and/or proximal jejunal injuries were enrolled. Primary repair was performed with adjunctive feeding jejunostomy, nasogastric decompression and drain placement. Data on demographics, injury details, vital signs, surgical procedures, and outcomes were collected from records of patient. Results: Of 27 patients, 15(55.6%) had duodenal injuries (18.5% first part, 37.0% fourth part), and 19 (70.4%) had proximal jejunal injuries, with 8(29.6%) having concurrent duodenal injuries. All patients presented after sustaining firearm injuries. Mean operation time was 110.1±38.9 minutes. Surgical site infections occurred in 04 patients, with no anastomotic leaks or reoperations. The most common AAST grade in duodenal injury was grade II in 12(80%) patients. Significant associations included ventilatory support with higher injury count (p<0.001) and longer hospital stay (p=0.005), spleen injury with increased surgical site infection risk (p=0.049) and prolonged stay (p=0.030), and shock index on arrival with stoma formation (p=0.002). No mortality was recorded and there was no anastamotic leak in patients. Conclusion: Primary repair with Witzel feeding jejunostomy is safe and effective for penetrating duodenal and proximal jejunal injuries, with low complication rates in a resource-limited setting.