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.