TH7.8 Delayed Diagnosis of Duodenal Injury in Blunt Abdominal Trauma following a normal initial Computed Tomography scan: A Systematic Review

Abstract

Abstract Aims Isolated duodenal injury and perforation can result from blunt abdominal trauma (BAT) in approximately 5% of patients with intrabdominal injuries. Modern major trauma pathways mandate computed tomography (CT) as part of the primary assessment. The evolution of a duodenal injury to a perforation can be delayed. The aim of this review is to ascertain the proportion of false negative CTs for duodenal perforation in BAT. Methods A systematic review of the literature was conducted using PubMed, Embase and OvidSP databases to include search terms “blunt abdo*”, “duoden*”, “trauma”, and “computed tomography” combined with Boolean operators. Data were extracted from studies that report data on patients following BAT with a normal initial CT who subsequently develop a perforation. Studies were limited to the last 10 years. Results There were 315 articles identified, which after excluding duplicates and screening, 18 articles were reviewed in detail and 6 articles (3 case studies and 3 retrospective cohort studies) included in the final review. Across the 6 studies, a total of 159 patients suffered BAT with 29 patients (18%) having a normal CT on admission. The majority of patients underwent a repeat CT within 24 hours which then subsequently revealed radiological signs of a duodenal injury/perforation. Conclusion Patients who present with following BAT should be closely observed for delayed clinical signs of visceral perforation. CT (preferably with oral contrast) should be performed if there is any clinical suspicion of perforation, even if the timeframe is within 24 hours of the initial CT scan.