Duodenal Trauma
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Basics
Description
- 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 first section
- Lies primarily over first 3 lumbar vertebrae
- Second 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
- Mortality occurs in 15–20%
- Late mortality usually from sepsis
Pediatric Considerations
- Majority secondary to recreational injuries (e.g., bicycle handlebar impact)
- 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 first 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 is required
Etiology
- 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 (MVC, assault, handlebar injury)
- Penetrating trauma:
- Most common cause of injury
- Creates cavitations, can lead to infection
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- 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 first section
- Lies primarily over first 3 lumbar vertebrae
- Second 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
- Mortality occurs in 15–20%
- Late mortality usually from sepsis
Pediatric Considerations
- Majority secondary to recreational injuries (e.g., bicycle handlebar impact)
- 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 first 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 is required
Etiology
- 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 (MVC, assault, handlebar injury)
- Penetrating trauma:
- Most common cause of injury
- Creates cavitations, can lead to infection
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