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Duodenal Trauma, Emergency Medicine

Christanne H. Coffey Reviewed 06/2017
 


Basics

Description

  • Characteristics of duodenum:

    • 12 in long

    • C-shaped

    • From pylorus to ligament of Treitz

    • Divided into 4 sections:

      • Last 3 sections retroperitoneal along with distal portion of 1st section

    • Lies m...

Diagnosis

Signs and Symptoms

  • Complaints may be minimal with vague abdominal, flank, and back pain

  • High GI obstruction may be seen with duodenal hematomas

History

Penetrating or blunt abdominal trauma 

Physical Exam

Treatment

Pre-Hospital

  • Follow trauma protocols

  • Important to have pre-hospital personnel provide clear description of mechanism of injury and to transport to appropriate facility

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • All patients with duodenal injuries need admission to trauma surgical service

  • Minor duodenal hematomas that do not require immediate surgery may require nasogastr...

Pearls and Pitfalls

  • Significant morbidity and mortality with delayed or missed diagnosis

  • Physical exam can be misleading due to retroperitoneal location

  • If continued high suspicion despite negative diag...

Additional Reading

  • Chen  GQ, Yang  H. Management of duodenal trauma. Chin J Traumatol.  2011;14(1):61–64.

  • Han  JH, Hong  SI, Kim  HS, et al. Multilevel duodenal injury after blunt trauma. J Korean...

Codes

ICD9

  • 863.21 Injury to duodenum, without open wound into cavity

  • 863.31 Injury to duodenum, with open wound into cavity

ICD10

  • S36.400A Unspecified injury of duodenum, initial encounter

  • S36.420A Contusi...

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