Duodenal hematoma

Anatomy of duodenum

Duodenal hematoma

  • Causes: Blunt trauma/non-accidental abuse, anticoagulation
  • Clinical diagnosis can be difficult as peritoneal signs are absent given the retroperitoneal location of the duodenum (2nd and 3rd part)
  • Delay in diagnosis more than 24 hours increases development of late complications (including pseudocysts, fistulas, pancreatitis, septicemia, or organ failure) and mortality.
  • Duodenal wall thickening with increased attenuation is seen with duodenal hematoma.
  • Main ddx is perforation of duodenum
    – Identification of extraluminal gas or oral contrast in the right anterior pararenal space (retroperitoneal space between the  posterior part of parietal peritoneum and anterior part of prerenal fascia)

    – If unsure, may need exploratory lap
  • Management
    – Intramural hematoma without perforation is managed conservatively and typically resolves in one to three weeks.
    – Duodenal perforation is a surgical emergency.
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