[Closed injuries of the retroperitoneal portion of the duodenum]

Closed injuries of retroperitoneal segment of the duodenum are very rare due to its small length and covering by the other organs. Almost half of these injuries are associated with injuries of the other organs. Pathoanatomical lesions are in the form of contusions, which may be overlooked by the surgeon if they are isolated, or as ruptures which require an operation. The author has treated four cases with ruptures which were most often located on the horizontal duodenal part and on the crossing from descending to the horizontal part. They were as consequences of kicks in the abdomen, traffic accidents and falls from heights. The mechanism of the injury involves hyperextension of the spinal column and sudden movement of the gastric and intestinal content. In the clinical picture dominate: pain irradiating to thorax, shoulder or flank, local tenderness and radiologically retroperitoneal and paravertebral collection of air. Because of quick deterioration of the signs, a clinical picture of peritonitis can develop, especially in association with the rupture of the other hollow-organs. In the injuries of the parenchimatous organs the signs of bleeding in the peritoneal cavity will dominate. Two of the four treated patients died.