Presentation
Working at car wash and was pinned between two cars at the level of the abdomen. Subsequently dragged approximately 3 meters. Now with increasing abdominal pain.
Patient Data
There is hyperdense retroperitoneal fluid anterior to the right kidney and anterior and between the aorta and IVC associated with multiple foci of punctate areas of increased attenuation.
Given the above findings, a CT of the abdomen/pelvis was then ordered to assess for active hemorrhage.
Interval development of a large amount of retroperitoneal air, most concentrated in close proximity to the duodenum, concerning for duodenal rupture.
No extravasation of contrast to suggest hemorrhage.
Case Discussion
This is a case of a duodenal perforation and a retroperitoneal hematoma arising from duodenal trauma. Initially, the patient underwent two exploratory laparotomies to create and then subsequent revise a jejunostomy. During the first exploratory laparotomy, there was a hematoma in the upper right retroperitoneal regon but no apparent source of bleeding was found. A follow-up angiogram also did not find an arterial source of bleeding. An exploratory laparotomy several days later (following the above triple phase CT abdomen/pelvis) subsequently found and repaired a previously undiscovered a perforation on the posterior aspect of the duodenum.
Following multiple abdominal washouts and temporary abdominal closure followed by fascial closure, the patient was discharged with outpatient follow-up. He was followed as an outpatient and appeared to be doing well without any symptoms.
Co-authors:
Joshua Goldwag
Patrick Tempera, DO
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