A 22-year-old man struck in the epigastrium by a bicycle handlebar presents 36 hours later with persistent vomiting and epigastric pain. CT abdomen shows a markedly thickened duodenal wall with narrowing of the second part of the duodenum and no free gas or leak. Serum amylase is mildly raised. The most likely diagnosis is:
- A Traumatic intramural haematoma of the duodenum ✓
- B Perforated duodenal ulcer
- C Transection of the duodenum at the duodenojejunal flexure
- D Retroperitoneal duodenal perforation with abscess formation
Correct answer: A. Traumatic intramural haematoma of the duodenum
Explanation
Blunt epigastric compression against the vertebral column, typical of handlebar injuries, can cause an intramural haematoma of the duodenum, presenting with delayed gastric outlet obstruction and a thickened duodenal wall on CT without free gas. In a stable patient without signs of perforation, conservative management with nasogastric decompression and parenteral nutrition is standard, and most resolve within two to three weeks.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.