Presentation
MVA into a concrete wall. Severe abdominal pain, worse in the RUQ. Obs stable. No altered LOC.
Patient Data
Large volume of extraluminal retroperitoneal free gas within the central abdomen to the right of midline adjacent the third part of the duodenum. Associated stranding of the mesentery in the upper abdomen extending into the pelvis with free fluid seen in the right paracolic gutter, right retroperitoneum and pelvis. Stranding of the subcutaneous tissues in the right flank and right side of the abdomen.
No liver, pancreas, kidney or spleen injury is evident. The IVC is patent. The portal vein opacifies normally.
The bladder is distended. No enlarged lymph nodes. No osseous abnormality.
IMPRESSION
Findings indicate a duodenal perforation with free air, free fluid and stranding centered adjacent the third part of the duodenum.
Case Discussion
The patient underwent an emergency laparotomy which confirmed a small full-thickness tear along the antimesenteric border of the third part of the duodenum (D3). Other intraoperative findings included:
- extensive bilious contamination of retroperitoneum along mesenteric root and D2 to D4
- RUQ retroperitoneal hematoma and bruising
- patchy saponification of root of mesentery and hepatic flexure mesentery
- pancreas intact, no evidence of other organ injuries
The perforation was oversewn and the patient recovered well.
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