Figure 1

Lacerations of D2-3 or D1-2-3 parts of duodenum not suitable for reconstruction with simple suture or Roux-en-Y closure. Duodenal reconstruction was achieved by distal and total duodenectomy with sparing pancreatic parenchyma. The distal duodenectomy with the end-to-end junction between the duodenum and jejunum at approximately 1 cm below the papilla (a). Total duodenectomy with end-to-end anastomosis between the duodenal cuff and the jejunum (b, c). The papilla was implanted to the side of the jejunum with (c) or without mucosal islet (b). Biliary stent (marked by arrow) prevented postoperative stricture of the anastomosis due to oedema (b). Pyloric exclusion (black arrow) as well as the T-tube enterocholangiostomy (white arrow) were performed to prevent anastomotic leak. The adjunct enterogastrostomy was not present in the figure (c).