Blunt duodenal rupture: a 6-year statewide experience.

OBJECTIVES

To characterize the incidence, presentation, diagnostic features, injury pattern, and mortality of blunt duodenal rupture.

METHODS

The records of 103,864 patients entered into a state-wide trauma registry during a 6-year period were screened for the diagnosis of blunt duodenal injury. The hospital records of all patients meeting diagnostic criteria of blunt duodenal rupture from 28 trauma centers were reviewed.

RESULTS

Blunt duodenal injury was identified in 206 (0.2%) patients. Thirty (14.5%) of these had full-thickness rupture of the duodenum. Of these 30 patients, 21 had been involved in motor vehicle crashes. Twenty-five presented with either abdominal pain, tenderness, or guarding on physical examination. Diagnostic peritoneal lavage was performed on 12 patients. Three patients were found to have isolated rupture of the duodenum. Computerized tomography was the primary diagnostic investigation in eighteen cases. Extravasation of contrast was noted in only two cases. Four studies were interpreted as normal. The second portion of the duodenum was most commonly injured, and there was a high incidence of associated intra-abdominal injuries. Seven patients underwent operation >12 hours after admission. Twenty-six patients survived to hospital discharge. Two deaths were caused by duodenal injury-related sepsis.

CONCLUSION

Blunt rupture of the duodenum is rare. Most blunt duodenal injuries do not result in full-thickness injury. The majority of patients with duodenal rupture presented with either a history or a physical examination suggestive of intra-abdominal injury. Computerized tomography results were often negative or nonspecific. Delay in diagnosis of duodenal rupture remains common but does not appear to affect mortality. Overall mortality was lower than previously reported.