Duodenal Perforation After Blunt Trauma: CT and Operative Correlation of an Unexpected Finding

Duodenal injury from blunt abdominal trauma is uncommon and often difficult to diagnose early due to its retroperitoneal location and nonspecific clinical presentation, which delays proper management and increases morbidity and mortality. A 32-year-old man sustained blunt abdominal trauma in a motor vehicle accident. CT showed active contrast extravasation from the first duodenum with moderate hemoperitoneum and associated American Association for the Surgery of Trauma (AAST) III liver lacerations. Exploratory laparotomy confirmed duodenal perforation treated by primary repair and feeding jejunostomy. Hepatic injuries were managed conservatively. Postoperative course was uneventful. Oral feeding was resumed three weeks later after removal of the jejunostomy tube. This case highlights the diagnostic challenges of blunt duodenal injuries and emphasizes the pivotal role of contrast-enhanced CT in their early detection. Direct imaging signs, although infrequent, are highly specific and should prompt urgent surgical management. A review of the literature confirms that early diagnosis, accurate injury grading, and tailored surgical repair are critical determinants of outcome, while delays beyond 24 hours markedly increase complication rates and mortality. High clinical suspicion, appropriate imaging, and timely operative intervention are keys to improving outcomes in blunt duodenal perforation.