[Retroperitoneal rupture of the duodenum caused by closed abdominal injury]

Preoperative diagnosis of retroperitoneal rupture of the duodenum is very difficult. Radiographical observation of air surrounding the right kidney or psoas muscle is of great assistance in this respect, but may only be expected in 30% of cases. Examination of the first segment of the digestive tract with the aid of "gastropgrafin" is advised. With the abdomen open, the presence of air, haematoma or bile in the transverse mesocolon or mesentery of the small intestine may be noted. In most cases, the breach can be closed with a double layer, leaving a drainage tube in the retroperitoneum. Measures than can be taken when suturing is unfeasable are also described.