Role of duodenography in the diagnosis of blunt duodenal injuries

C. H. Timaran, B. J. Daley, B. L. Enderson

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The differentiation of duodenal perforation from duodenal hematoma is not always possible with computed tomography (CT). Our diagnostic guideline has included duodenography to investigate CT findings of periduodenal fluid or wall thickening. However, the utility of duodenography as a diagnostic study in blunt abdominal trauma is not defined. We evaluated duodenography as a diagnostic test in patients with suspected blunt duodenal injuries (BDIs). Methods: During a 10-year period, 96 patients out of 25,608 trauma admissions had CT findings of possible BDI and underwent duodenography. Demographic and clinical data, diagnostic methods, and management were derived from prospectively collected data. CT and duodenography studies were reviewed and correlated with surgical findings and outcome. All CT scans were obtained with intravenous contrast; oral contrast was used in 32 patients. Duodenography was analyzed using the 2 X 2 method and Bayes theorem. Results: Indications for duodenography included periduodenal fluid without extravasation (76%), abnormal duodenal wall thickening (16%), and retroperitoneal extraluminal gas (5%). Eighty-six duodenography studies were reported as normal, six were consistent with hematoma, one was indeterminate, and only three revealed extravasation. Two of these three patients with duodenal perforation had retroperitoneal extraluminal air. Only one patient underwent exploration on the basis of duodenography. No blunt duodenal perforation was diagnosed by CT. Overall, duodenography had sensitivity of 54% and specificity of 98%. For BDIs requiring repair, duodenography sensitivity was only 25%; the false-negative rate was also 25%. Retroperitoneal extraluminal air was a useful sign of duodenal perforation, occurring in two of three patients with BDI and only in one without BDI (p < 0.001). Conclusion: Duodenography has a low sensitivity in patients with suspected BDI by CT findings and is of minimal utility in diagnostic evaluation. Retroperitoneal extraluminal air seen on CT is an important sign of BDI requiring surgical repair.

Original languageEnglish (US)
Pages (from-to)648-651
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number4
StatePublished - 2001

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Nonpenetrating Wounds
Tomography
Air
Hematoma
Bayes Theorem
Wounds and Injuries
Routine Diagnostic Tests
Gases
Demography
Guidelines
Sensitivity and Specificity

ASJC Scopus subject areas

  • Surgery

Cite this

Role of duodenography in the diagnosis of blunt duodenal injuries. / Timaran, C. H.; Daley, B. J.; Enderson, B. L.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 51, No. 4, 2001, p. 648-651.

Research output: Contribution to journalArticle

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abstract = "Background: The differentiation of duodenal perforation from duodenal hematoma is not always possible with computed tomography (CT). Our diagnostic guideline has included duodenography to investigate CT findings of periduodenal fluid or wall thickening. However, the utility of duodenography as a diagnostic study in blunt abdominal trauma is not defined. We evaluated duodenography as a diagnostic test in patients with suspected blunt duodenal injuries (BDIs). Methods: During a 10-year period, 96 patients out of 25,608 trauma admissions had CT findings of possible BDI and underwent duodenography. Demographic and clinical data, diagnostic methods, and management were derived from prospectively collected data. CT and duodenography studies were reviewed and correlated with surgical findings and outcome. All CT scans were obtained with intravenous contrast; oral contrast was used in 32 patients. Duodenography was analyzed using the 2 X 2 method and Bayes theorem. Results: Indications for duodenography included periduodenal fluid without extravasation (76{\%}), abnormal duodenal wall thickening (16{\%}), and retroperitoneal extraluminal gas (5{\%}). Eighty-six duodenography studies were reported as normal, six were consistent with hematoma, one was indeterminate, and only three revealed extravasation. Two of these three patients with duodenal perforation had retroperitoneal extraluminal air. Only one patient underwent exploration on the basis of duodenography. No blunt duodenal perforation was diagnosed by CT. Overall, duodenography had sensitivity of 54{\%} and specificity of 98{\%}. For BDIs requiring repair, duodenography sensitivity was only 25{\%}; the false-negative rate was also 25{\%}. Retroperitoneal extraluminal air was a useful sign of duodenal perforation, occurring in two of three patients with BDI and only in one without BDI (p < 0.001). Conclusion: Duodenography has a low sensitivity in patients with suspected BDI by CT findings and is of minimal utility in diagnostic evaluation. Retroperitoneal extraluminal air seen on CT is an important sign of BDI requiring surgical repair.",
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