Desai et al listed diagnostic features associated with duodenal injury secondary to blunt trauma in children. Early diagnosis is difficult and depends on a high index of clinical suspicion. The authors are from Washington University and St. Louis Children's Hospital in St. Louis.


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.


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