MEDizzy - Following blunt abdominal trauma, a 12-year-old girl

Feed Library Learning Discuss Leaderboard Journal

Trauma II

Following blunt abdominal trauma, a 12-year-old girl develops upper abdominal pain, nausea, and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. In the absence of other suspected injuries, which of the following is the most appropriate management of this patient?

ExplanationB. Duodenal hematomas result from blunt abdominal trauma, and they should be managed initially with observation in patients not undergoing laparotomy to rule out other associated injuries. They present as a proximal bowel obstruction with abdominal pain and occasionally a palpable right upper quadrant mass. An upper gastrointestinal series is almost always diagnostic, with the classic coiled spring appearance of the second and third portions of the duodenum secondary to the crowding of the valvulae conniventes (circular folds) by the hematoma. Observation is the initial management strategy in patients with no other injuries, since the vast majority of duodenal hematomas resolve spontaneously. However, in patients undergoing immediate laparotomy for other associated injuries, duodenal exploration with drainage of the hematoma is indicated. Also, patients whose obstructive symptoms do not resolve after 2 weeks should undergo exploration and evacuation of the hematoma in order to rule out a perforation or injury to the head of the pancreas. Surgical bypass and duodenal resection are not indicated in the initial management of a duodenal hematoma.