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Duodenal Trauma

Duodenal Trauma is a topic covered in the 5-Minute Emergency Consult.

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  • Characteristics of duodenum:
    • 12 in long
    • C-shaped
    • From pylorus to ligament of Treitz
    • Divided into 4 sections:
      • Last 3 sections retroperitoneal along with distal portion of 1st section
    • Lies mostly over 1st 3 lumbar vertebrae
    • 2nd section is most commonly injured
  • Types of injury:
    • Duodenal wall hematoma
    • Wall perforation
    • Hemorrhage, including retroperitoneal
    • Crush
  • Incidence of duodenal injury is 3–5% of all traumatic abdominal injuries
  • Penetrating trauma accounts for ∼75% of duodenal injuries:
    • Mortality ranges from 13–28%
    • Associated with exsanguination
  • Blunt duodenal trauma has a higher mortality due to greater force of injury and often delayed diagnosis due to retroperitoneal location:
    • If injury is diagnosed in <24 hr, mortality rate is about 11%
    • If >24 hr, mortality rate approaches 40%
    • Late mortality usually from sepsis

Pediatric Considerations
  • Majority secondary to recreational injuries (e.g., bicycle handlebar injuries)
  • Intramural duodenal hematomas may occur in nonaccidental trauma:
    • If suspected, prompt referral to appropriate child protective agency is required
  • In children, hematoma is most commonly seen in 1st portion of duodenum

Pregnancy Considerations
  • Retroperitoneal hemorrhage more common due to increased pelvic and abdominal vascularity
  • Large uterus serves as protection from bowel injury.
  • Peritoneal irritation is blunted in the pregnant patient; therefore, greater index of suspicion


  • Blunt trauma:
    • Shear strain: Abrupt acceleration/deceleration at point of attachment (most common retroperitoneal injury with rapid deceleration)
    • Tensile strain: Direct compression or stretching of tissue
  • Penetrating trauma:
    • Most common cause of injury
    • Creates cavitations, can lead to infection

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Rosen, Peter, et al., editors. "Duodenal Trauma." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307536/all/Duodenal_Trauma.
Duodenal Trauma. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307536/all/Duodenal_Trauma. Accessed April 23, 2019.
Duodenal Trauma. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307536/all/Duodenal_Trauma
Duodenal Trauma [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307536/all/Duodenal_Trauma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Duodenal Trauma ID - 307536 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307536/all/Duodenal_Trauma PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -