Mechanism of injury:
(1) motor vehicle collision, especially with lap belt injury
(2) handlebar impact
(3) physical blow to the upper abdomen (abuse, fight)
(4) falling object
(5) other blunt trauma to the upper abdomen
Types of injury:
(1) perforation secondary to tear
(2) hematoma
Clinical findings:
(1) nausea and vomiting
(2) abdominal pain
(3) diffuse abdominal tenderness
(4) evidence of trauma to pancreas, liver or spleen
The hematocrit may be low if a hematoma is present.
Imaging studies on CT scans:
(1) air in the peritoneum and/or retroperitoneum
(2) retroperitoneal fluid
(3) duodenal wall thickening
(4) periduodenal soft tissue mass
Extravasation of oral contrast material was insensitive for the diagnosis of perforation.
Duodenography may be useful when there is a high index of clinical suspicion and CT scan findings are nondiagnostic.
A repeat CT scan after 6 or more hours may be helpful if the initial CT scan is negative (page 646).
If laparotomy is performed, then the entire duodenum should be mobilized to detect subtle injuries in the retroperitoneal portion.
