Gastroduodenal Trauma

 High-density intramural hematoma, pneumoperitoneum, anterior pararenal space fluid/air



• Upper GI findings
image Duodenal lumen narrowing by hematoma; contrast extravasation (peritoneal cavity, retroperitoneum)

• Best imaging tool: CECT, upper GI




TOP DIFFERENTIAL DIAGNOSES




• Perforated duodenal ulcer

• Villous adenoma

• Duodenal lymphoma


CLINICAL ISSUES




• Clinical profile
image Child with midepigastric blunt trauma, adult with high-speed motor vehicle crash injuries

image Other forms of blunt trauma (e.g., assault, sports injuries)

image Iatrogenic injuries include endoscopy, especially with endoscopic sphincterotomy/papillotomy and stone removal from common duct

• Most common signs/symptoms
image Nausea, vomiting, abdominal pain/tenderness

• Treatment
image Nonoperative management for isolated hematoma without perforation

image Surgery for duodenal perforation and head of pancreas injury (pancreaticoduodenal resection;modified Whipple)


DIAGNOSTIC CHECKLIST




• Consider perforated duodenal ulcer

• Clinical features are usually distinctive

image
(Left) Axial CECT in a 16-year-old boy with blunt abdominal trauma shows a high-attenuation mass image within the duodenal wall (hematoma) that narrows the duodenal lumen.


image
(Right) Another CT section in the same case shows the intramural hematoma image extending into and narrowing the lumen of the 3rd portion of duodenum. This resulted in partial gastric outlet obstruction but resolved over the next 10 days with nonoperative management.

image
(Left) CT in a 25-year-old man had blunt trauma shows extensive fluid &/or infiltration of the anterior pararenal and perirenal image spaces. Signs of pancreatic injury include indistinct appearance of the pancreatic head, a thin fracture plane through the neck image, and fluid between the pancreas and the splenic vein image.


image
(Right) Another CT section in the same patient shows gas bubbles image adjacent to the duodenum indicating duodenal perforation (confirmed at surgery) along with pancreatic transection.


TERMINOLOGY


Definitions




• Trauma to duodenum resulting in intramural hematoma or laceration


IMAGING


General Features




• Best diagnostic clue
image CT: High-density intramural hematoma, pneumoperitoneum
– Anterior pararenal space fluid or gas


Radiographic Findings




• Radiography
image Pneumoperitoneum, extraluminal retroperitoneal gas


Fluoroscopic Findings




• Upper GI
image Duodenal lumen narrowing by hematoma
– Oral contrast extravasation

Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Gastroduodenal Trauma

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