The lethal potential of duodenal trauma relates to the severity of the defect, associated injuries, and the adequacy and expedience of treatment. We studied 247 patients whose injuries were managed at a single institution during an 18-year period. Emphasis was placed on complications directly related to the duodenal wound and the selection of operative repair. Repairs consisted of duodenorrhaphy in 190 patients (83%) and more complex procedures in 33 (13%). Death resulted from the duodenal injury in nine patients (4%) and fistula developed in 16 (7%). Factors associated with an increase in the morbid potential of the duodenal wound were (1) missile or blunt injury, or a defect larger than 75% of the circumference; (2) injury of the first or second portion; (3) an injury-operation delay of more than 24 hours; and (4) adjacent common bile duct injury. These factors require consideration in the selection of the operative repair.