A 6-year-old boy presented with abdominal pain and vomiting after a history of blunt abdominal trauma. Ultrasounds showed biliary sludge initially leading to a diagnosis of acute cholecystitis, but the patient did not improve with medical treatment. Repeated ultrasound then revealed an epigastric mass. A CT scan confirmed a duodenal hematoma from the trauma. The boy underwent surgery where the duodenal injury was repaired. Duodenal injuries from blunt trauma can be difficult to diagnose but require suspicion and exploration if certain intra-operative findings are present.

2. Duodenal Trauma
in Pediatrics
Presented by:
Mahmoud Motawea
Assistant Lecturerof Pediatric Surgery

3. History
 Male child aged 6 years.
 Presented with history of abdominal
pain and repeated vomiting, gastric
in nature at first then became bilious
that started 48 hours ago.
 With further and thorough history
taking, the parents mentioned a
history of blunt abdominal trauma.

4. History
 The parents sought medical advice,
ultrasound was requested and
showed biliary sludge with no other
abnormalities.
 So, Diagnosis of acute cholecystitis
was considered.

5. History
 The patient didn’t improve on medical
treatment.
 Ultrasound was repeated, showing an
epigastric mass.

6. Examination & investigations
When the patient presented to us:
Examination showed diffuse
abdominal tenderness mainly epigastric.
No mass was felt clinically.
Ultrasound was repeated and showed
query duodenal hematoma, CTabdomen
and pelvis followed U/S confirming the
diagnosis.

7. Examination & investigations

8. Examination & investigations

9. Examination & investigations

10. Examination & investigations

11. Surgical intervention

12. Surgical intervention

13. Surgical intervention

14. HomeMessage
Duodenal injuriesareuncommon and both difficult to
diagnoseand repair.
Diagnosisismoredifficult in blunt injuriesand requires
high index of suspicion.
No specific diagnostic test found to be accurate all of the
time.
Intra-op findingsthat requireexploration:
 Crepitusalong theduodenal sweep
 Bilestaining of paraduodenal or adjacent tissues
 Right-sided retroperitoneal or periduodenal hematoma