Sir,

During a 3 years period (April 1983 to March 1985), 8 patients with duodenal injury (Table) were managed operatively in the South Surgical Unit of Mayo Hospital. Duodenal per­foration were repaired in 7 patients while in 1, who had a duodenal wall haematoma was treated expectantly. Nasojejunal feeding tube were intro­duced at operation in 7 patients in addition to nasogastric tubes for decompressing the stomach. Two of these patients developed Fistulae which closed spontaneously while the patients were maintained on jejunal feeding. A nasojejunal tube was introduced under radiological control after the development of a duodenal Fistula in 1 patient. In this patient the Fistula also closed spontaneously while jejunal tube feeding was maintained. One other patient with duodenal and in­ferior vena caval tear died as a result of secondary haemorrhage which coincided with the develop­ment of a duodenal Fistula. A nasojejunal tube was not used in this patient.

The use of a nasojejunal passed at the time of surgery in duodenal injury is proposed. It patients with Fistulae, to maintain tube feeding while awaiting spontaneous closure.

Shafiq Saleemi, Ashfaq Ahmad, Raja M. Ashraf
South Surgical Unit, K.E.M.C., Mayo Hospital, Lahore.