Gastroduodenal Trauma

R. Brooke Jeffrey, MD

Key Facts

Terminology

Trauma to duodenum resulting in intramural hematoma or laceration

Imaging

Best diagnostic clue
- High-density intramural hematoma, pneumoperitoneum, anterior pararenal space fluid/air
Upper GI findings
- Duodenal lumen narrowing by hematoma; contrast extravasation (peritoneal cavity, retroperitoneum)
Best imaging tool: CECT, UGI

Top Differential Diagnoses

Perforated duodenal ulcer
Villous adenoma
Duodenal lymphoma

Clinical Issues

Clinical profile
- Child with mid-epigastric blunt trauma, adult with high-speed motor vehicle crash injuries
Most common signs/symptoms
- Nausea, vomiting, abdominal pain/tenderness
Treatment
- Nonoperative management for isolated hematoma without perforation
- Surgery for duodenal perforation and head of pancreas injury

Diagnostic Checklist

Consider perforated duodenal ulcer

(Left) Axial CECT in a 25-year-old man injured in a motor vehicle crash demonstrates free intraperitoneal air

. (Right) Axial CECT in the same patient reveals free intraperitoneal fluid

, as well as extraluminal fluid

immediately adjacent to the 2nd portion of the duodenum. CT findings of duodenal laceration can be subtle, but prompt diagnosis and therapy are crucial, as morbidity and mortality rise exponentially with delays in diagnosis.