PS02P DELAYED PRESENTATION OF DUODENAL HEMATOMA AND ACUTE PANCREATITIS FOLLOWING A SEATBELT INJURY

Abstract

Purpose: Intramural duodenal hematoma is a rare duodenal injury, usually occurring in association with blunt abdominal trauma. Diagnostic and therapeutic implementations remain controversial. We present a case of delayed onset of such an injury complicated by acute pancreatitis following a MVA.Methodology: A 15‐year old male re‐presented to the emergency department four days after involvement as a restrained rear seat passenger in a front‐on collision at 60 km per hour. In the absence of demonstrable external injury or clinical signs of trauma, the patient was discharged home following six hours of stable observation. Over the subsequent four days, he developed increasing abdominal distension and pain for which he represented to the hospital.Results: On examination the patient was hypovolaemic and tachycardic with a tense, distended abdomen with few bowel sounds. An abdominal CT demonstrated significant duodenal hematoma. An oral Gastrografin meal study performed six hour later showed complete gastric outlet obstruction. The patient was managed conservatively with a NG aspirations and TPN. He developed high lipase levels a couple of days later suggesting delayed manifestation of pancreatic injury. A repeat CT scan however was negative. A repeat gastrografin meal on day 18 revealed complete resolution of the gastric outlet obstruction.Conclusion: This case emphasises the characteristic delayed presentation of duodenal hematoma following a blunt abdominal trauma and associated sequelae of delayed pancreatitis. Total parenteral nutrition and gastric decompression provides an effective conservative treatment of gastric outlet obstruction associated with this injury.