Objective:To study  the operative method for severe duodenal trauma.
Methods:The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.
Results:In 8 cases duodenal diverticulization was performed, of which 5 cases were cured, 2 cases developed intestinal fistula, and one  died.Of 9 cases who underwent panceaticoduodenectomy(PD), 3 were cured but 6 had pancreatic leakage, and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture, 13 cases cured, 2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy (PD with preserved duodenum), 4 cases recovered and 1 had pancreatic leakage, but 3 with wrap-type pancreaticojejunostomy had no complications.
Conclusions:The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma. This procedure plus removal of head of pancreas and  pancreaticojejunostomy (PD with preserved duodenum) can be used for severe pancreatic injury with excellent result, but duodenal diverticulization or  panceaticoduodennectomy must not be undertaken lightly.