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