Ten cases of penetrating injuries to the duodenum are presented. Six injuries were treated with primary repair, retrograde decompressing jejunostomy, and feeding jejunostomy. There was no postoperative duodenal leak in any patient treated with primary repair and retrograde decompressing jejunostomy. In a review of 563 cases of penetrating duodenal trauma, the superiority of primary repair of duodenal injuries with decompression of the suture line by a tube inserted in a remote site of the bowel (stomach or jejunum) was demonstrated. This technique afforded the lowest mortality and incidence of postoperative duodenal fistulae. When applicable, primary repair with retrograde decompressing jejunostomy and feeding jejunostomy is a rapid, simple, and safe method for the treatment of penetrating duodenal injuries.