Traumatic duodenal rupture
Child with trauma, presented to the OR in early shock.
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Marked free intraperitoneal fluid collection.
Hypoenhancement and disruption of the wall of the 3rd part of the duodenum. The area is surrounded by a retroperitoneal fluid collection. Contrast leaks out of the duodenum, causing increased attenuation of the collection.
Free intraperitoneal gas. Multiple gas foci around the inferior vena cava and portal vein radicles.
These findings were confirmed at surgery but sadly the patient died two days later.
Bowel injury is an uncommon but dangerous sequela of blunt force injury. The duodenum is at risk for compression injury due to is position in front of the spine, which can act as an anvil for an AP force. It is also at risk for shearing injury, given that the ligament of Treitz is fixed in position.