Duodenal hematoma results in hematoma formation in the duodenal wall. It may occur as a result of blunt abdominal trauma, non-accidental injury to children and spontaneously in anti-coagulated patients.
Distinction must be made from duodenal perforation since the latter will require immediate surgical management. Unfortunately, the distinction is not always easy radiologically and where diagnostic doubt persists, an exploratory laparotomy may be performed.
An isolated hematoma will classically have heterogeneous attenuation and a thickened duodenal wall. Fluid collection without contrast can be seen in both perforation and hematoma while extravasation of oral contrast and/or extraluminal gas in the retroperitoneum (right anterior pararenal space) are specific for perforation.
A hematoma in isolation can be treated conservatively: nasogastric tube decompression with resolution expected in 1-3 weeks.
- 1. JR Kunin "Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma" AJR Vol 160, 1221-1223 1993