Following blunt abdominal trauma, A 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is
|B||Nasogastric suction and observation|
a. Duodenal hematomas are caused by a direct blow to the abdomen and occur more often in children than adults.
b. Blood accumulates between the seromuscular and submucosal layers, eventually causing obstruction.
c. The diagnosis is suspected by the onset of vomiting following blunt abdominal trauma; barium examination of the duodenum reveals either the coiled spring sign or obstruction.
d. Most duodenal hematomas in children can be managed nonoperatively with nasogastric suction and parenteral nutrition.
e. Resolution of the obstruction occurs in the majority of patients if this therapy is continued for 7 to 14 days.
f. If surgical intervention becomes necessary, evacuation of the hematoma is associated with equal success but fewer complications than bypass procedures.
g. Despite few existing data on adults, there is no reason to believe that their hematomas should be treated differently from those of children.
h. A new approach is laparoscopic evacuation if the obstruction persists more than 7 days.