Clinical Presentation

A 16-year-old boy is brought to the emergency department by his father. He complains of intense midepigastric abdominal pain.

Single-contrast barium study shows an abrupt transition at the third portion from normal duodenum (arrow) to a segment with thin, stretched valvulae conniventes (arrowhead).

Differential Diagnosis

• Intramural duodenal hematoma: This is the most likely choice because of the coiled spring appearance of the duodenum on the barium study and the clinical history.

• Intussusception: This is a second option that can cause a coiled spring appearance, but it is unlikely to occur in fixed locations such as the duodenum.

• Intraluminal mass: This could have a similar appearance but would be unlikely, given the patient’s age. Consider lipomas and windsock diverticula.

Essential Facts

• This case reviews the differential diagnosis for a coiled spring appearance of the small bowel.