A 35-year-old man driving without a seatbelt strikes his abdomen on the steering wheel in a head-on collision. He complains of persistent epigastric pain and repeated vomiting over 12 hours. He is haemodynamically stable. Serum amylase is mildly elevated. CT abdomen shows retroperitoneal air and fluid adjacent to the third portion of a fixed retroperitoneal segment with no free intraperitoneal air. The most likely injured organ is:
- A Pancreatic body
- B Proximal jejunum
- C Second and third parts of the duodenum ✓
- D Gastric antrum
Correct answer: C. Second and third parts of the duodenum
Explanation
Crush of the duodenum against the vertebral column, classically by a steering wheel, causes retroperitoneal duodenal rupture. Because the duodenum is secondarily retroperitoneal, leakage produces retroperitoneal air and fluid with mild amylase rise and no free intraperitoneal air, explaining delayed subtle presentation. Pancreatic injury alone gives fluid and stranding without retroperitoneal gas. Jejunal and gastric injuries are intraperitoneal and produce free intraperitoneal air and peritonitis, which this patient lacks.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.