A 12-year-old boy struck in the upper abdomen by a bicycle handlebar presents 24 hours later with epigastric pain, persistent vomiting and low-grade fever. There is mild tenderness but no peritonism. CT abdomen shows retroperitoneal air anterior to the right kidney and thickening of the duodenal wall. The most likely diagnosis is:
- A Retroperitoneal duodenal perforation ✓
- B Traumatic pancreatic pseudocyst
- C Perforated gastric ulcer
- D Superior mesenteric artery syndrome
Correct answer: A. Retroperitoneal duodenal perforation
Explanation
Blunt compression of the duodenum against the vertebral column, classically by a handlebar, causes retroperitoneal second part duodenal rupture. Because the leak is retroperitoneal there is no early peritonitis, and the presentation is delayed with vomiting and epigastric pain. The diagnostic clue on CT is extraluminal retroperitoneal air and fluid around the right kidney and duodenum. Intraperitoneal perforations such as gastric ulcer produce free intraperitoneal air instead, and pancreatic injury alone does not generate gas.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.