M. L. Peterson1,2, P. I. Abbas1,2, S. C. Fallon1,2, B. J. Naik-Mathuria1,2, J. R. Rodriguez1,2 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Divison Of Pediatric Surgery,Houston, TX, USA
Introduction: Duodenal hematomas due to blunt abdominal trauma are uncommon in children. The natural history of this injury has not been well-characterized. Treatment strategies range from non-operative management to surgical decompression. The purpose of this study was to review the experience with this injury at a large volume children’s hospital.
Methods: After IRB approval, a retrospective case series was assembled containing patients with duodenal injuries secondary to blunt abdominal trauma from 2003-2014. Patients were identified through the trauma registry and validated through ICD-9 codes. Children with duodenal perforations or deserosalization injuries not associated with a hematoma were excluded. Data collection included demographics, clinical and radiographic characteristics, and hospital course. Patients with Grade I injuries based on the AAST duodenal organ injury scale were compared to those with Grade II injuries. Statistical analysis included student’s T-test and chi square.
Results: Twenty-seven patients were identified with blunt abdominal trauma resulting in duodenal injury; 19 patients (32% female) met inclusion criteria at a mean age of 9.1 ± 4.5 years. Mechanisms of injury included direct abdominal blow/handle bar injury (n=9), non-accidental trauma (n=5), falls (n=3) and motor vehicle accident (n=2). Grade I hematomas were present in 53%, and Grade II in 47% (Table 1). Hematomas were most frequently seen in the second portion of the duodenum (n=9). CT scan was the diagnostic test of choice in all patients; 10 had associated injuries (pancreas, liver, and/or other small bowel) with five (26%) of these patients undergoing a laparotomy for concerns for hollow viscous injury. No patients underwent operative drainage of the hematoma; however, one patient was treated with percutaneous drainage. Twelve patients received parenteral nutrition (PN) for a median duration of 9.3 days (range 5-14 days). Complications included readmission for concern of obstruction requiring further bowel rest (n=1). No patients developed infection of the hematoma.
Conclusion: Duodenal hematomas as a consequence of blunt abdominal trauma in children can be successfully managed non-operatively. There is acceptable morbidity, particularly with regards to the duration of parenteral nutrition, using this strategy. The AAST grade of duodenal hematoma is associated with longer duration of PN therapy and consequently longer hospital stays. These data can assist in care management planning and parental counseling.
