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Duodenal Trauma Updated 12/2010

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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Characteristics of duodenum:
    • 12 inches long
    • C-shaped
    • Divided into 4 sections:
      • Last 3 sections retroperitoneal along with distal portion of 1st section
    • Lies mostly over 1st 3 lumbar vertebrae
    • 2nd section is most commonly injured
  • Types of injury:
    • Duodenal wall hematoma
    • Wall perforation
    • Hemorrhage, including retroperitoneal
    • Crush
  • Incidence of duodenal injury is ~5% of all intra-abdominal injuries.
  • Penetrating trauma accounts for ~75% of duodenal injuries:
    • Mortality ranges from 13–28%.
    • Associated with exsanguination
  • Blunt duodenal trauma has a higher mortality due to greater force of injury and often delayed diagnosis due to retroperitoneal location:
    • If injury is diagnosed in <24 hr, mortality rate is about 11%.
    • If >24 hr, mortality rate approaches 40%.
    • Late mortality usually from sepsis
ALERT: Pediatric Considerations
  • Majority secondary ...

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