abstract traumatic duodenal perforation requires emergent surgery whereas duodenal hematoma can often be treated nonsurgically we assessed the ct findings in patients with blunt duodenal trauma to determine if ct can be used to differentiate these two duodenal injuries

duodenal hematoma basics the duodenum is relatively protected given its retroperitoneal location injuries to the duodenum are uncommon sowrey 2013 lt 1 of traumas involved the pediatric duodenum clendenon 2004 unfortunately historic data shows high mortality rates for those with duodenal injuries although more recent data has lower

unreliable in detecting isolated duodenal and other retroperitoneal injuries but dpl is often helpful because of 40 of patients have associated intra abdominal injuries that will result in a positive dpl the finding of amylase or bile are more specific indicators of possible duodenal injury

t1 role of duodenography in the diagnosis of blunt duodenal injuries au timaran c h au daley b j au enderson b l py 2001 y1 2001 n2 background the differentiation of duodenal perforation from duodenal hematoma is not always possible with computed tomography ct

duodenal perforation is suspected if there is a retroperitoneal collection of contrast medium extraluminal gas or a lack of continuity of the duodenal wall duodenal contusion is suspected with edema or hematoma of the duodenal wall intramural gas accumulations and focal duodenal wall thickening gt 4 mm as findings of small bowel injury

duodenal hematoma results in hematoma formation in the duodenal wall it may occur as a result of blunt abdominal trauma non accidental injury to children and spontaneously in anti coagulated patients distinction must be made from duodenal perforation since the latter will require immediate surgical management unfortunately the distinction is not always easy radiologically and where diagnostic doubt persists an exploratory laparotomy may be performed

duodenal perforation following blunt abdominal trauma is an extremely rare and often overlooked injury leading to increased mortality and morbidity we report two cases of isolated duodenal injury following blunt abdominal trauma and highlight the challenges associated with their management in both

duodenal hematoma duodenal injury duodenal perforation pancreaticoduodenectomy pyloric exclusion small bowel injury whipple procedure definition pancreatic trauma and duodenal trauma are considered together because of the close anatomic relationship shared blood supply and frequency of combined injuries

the incidence of pancreatic injury in blunt abdominal trauma ranges from 0 2 to 12 with mortality rates as high as 30 1 the pancreas and duodenum are commonly injured simultaneously with an incidence of 50 98 often also involving the left hepatic lobe and spleen 2 6 isolated pancreatic injuries are rare occurring with an incidence of less than 30 2 6 mortality and morbidity

duodenal contusion is suspected with edema or hematoma of the duodenal wall intramural gas accumulations focal duodenal wall thickening gt 4 mm as findings of small bowel injury fluid or a hematoma in the retroperitoneum stranding of retroperitoneal fatty tissue or pancreatic transection can be present in both conditions

the majority of duodenal injuries in children result in a duodenal hematoma without disruption of the lumen when there is perforation computed tomography demonstrates extraluminal gas or oral contrast extravasation in the right anterior pararenal space thickening of the duodenal wall is seen when a duodenal hematoma is present

although the majority of injuries to the pancreas and duodenum are low grade and can be managed with minimal surgical intervention complex injuries require timely pancreatic and or duodenal resection and reconstruction the mechanisms associated injuries diagnosis and management of duodenal and pancreatic injury are reviewed here

introduction duodenal injuries are uncommon and are associated with significant morbidity and mortality due to delayed diagnosis in the case of blunt trauma or associated major vascular injuries

if the duodenal injuries were classified starting from total destruction or not of the duodenal wall then there would be the duodenal hematoma without perforation duodenal laceracion and duodenal transection based on that division and the factors determining the gravity of duodenal injuries we can then determine the proper treatment

children with duodenal hematoma resumed eating an average of 16 days after injury only one child required surgery for persistent obstruction the findings of retroperitoneal air and contrast extravasation on ct accurately distinguish duodenal perforation from hematoma conservative management of hematoma is safe and effective

management of duodenal injuries in children be administered if a question remains regarding perforation 29 hematocrit was also found to be significantly lower in duodenal hematoma versus

duodenal perforation is a rare life threatening injury associated with non accidental blunt abdominal trauma diagnostic delay is common as the true history is concealed and signs may be minimal double contrast computed tomography is the most sensitive investigation to confirm clinical suspicion

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suture of perforated ulcer wound or injury of stomach or upper small bowel suture of gastric injury suture of perforated duodenal ulcer gastrorrhaphy sutr prf8 duol gstr ulcer wnd inj suture of perforated gastric ulcer suture of duodenal injury

duodenal injuries continue to be challenging diagnostic and treatment problems a review of current diagnostic techniques and options for management is presented emphasis is placed on trying to match the severity of the injury with the appropriate treatment procedure

how duodenal injuries there was a 64 incidence of abdominal sepsisever if adequate mobilization for a tension free repair is impossible and a 27 death rate in 11 patients with duodenal gunshot wounds or if the injury is very near the ampulla and mobilization risks com compared with a 7 abdominal sepsis and 0 mortality inmon bile duct

penetrating injuries to the stomach small intestine and duo denum as practiced at the elvis presley memorial trauma center in memphis tennessee the approach to diagnostic workup of penetrating abdominal injury is left for another discussion herein we will focus on the conduct of the lapa rotomy in general and the specific management of

background duodenal hematoma dh is a rare complication of esophagogastroduodenoscopy egd with duodenal biopsy and uncommon but better described following blunt abdominal trauma bat we aimed to describe dh incidence and investigate risk factors for dh development post egd and compare its features to those post bat

duodenal hematoma duodenal haematoma presentation epidemiology traumatic injuries continue to be the leading cause of death in children far surpassing other causes in frequency 6 abdominal trauma accounts for 8 10 of all trauma admissions to pediatric hospitals

this topic will review blunt hollow visceral injuries in children including mesenteric injury duodenal hematoma and perforation of the stomach small intestine and colon evaluation and management of traumatic liver pancreas and splenic injuries in children are discussed separately

of the 19 79 with duodenal hematomas computed tomographic ct scan alone identified 15 and the remaining 4 were confirmed by duodenography incision and drainage of a hematoma was performed in two children duodenal perforation was identified in five 21 children

1 there is thickening of the duodenal wall with irregularity in the lumen 2 adjacent to the duodenum there is increased attenuation with fluid in the anterior perineal space on the right

stomach pain may become worse after eating or you may feel uncomfortable full complications serious complications of a duodenal ulcer can occur including a bleeding ulcer or perforation during perforation the ulcer extends through the wall of the duodenum and can cause acid and food to leak into the abdomen causing severe pain

duodenal perforation is an uncommon complication of endoscopic retrograde cholangio pancreatography ercp and a rare complication of upper gastrointestinal endoscopy most are minor perforations that settle with conservative management a few perforations however result in life threatening retroperitoneal necrosis and require surgical intervention

it has been reported that the causes of horizontal duodenal perforation are trauma or iatrogenic injury due to ercp mainly duodenal injury is present on average in 3 7 5 of abdominal injuries and may be due to either blunt trauma of the abdomen or penetrating injuries 6

07 Childhood Trauma Abdominal Trauma Thoracic Trauma