Retroperitoneal duodenal tears occupy a particular place among subcutaneous intestinal ruptures of traumatic origin. The integrity of the peritoneum creates diagnostic difficulties during the first hours after the trauma.
According to the statistical reports of Kenn,1 only 9 of 138 patients with retroperitoneal and intraperitoneal duodenal ruptures recovered. Retroperitoneal ruptures are often overlooked during laparotomy (Gibe2). The presence of retroperitoneal hematoma, emphysema or a green spot on the parietal peritoneum makes the surgeon suspect ruptures of the retroperitoneal hollow organs. The diagnosis is most difficult in cases in which there are injuries of other viscera. In case of blunt trauma to the abdomen, after manipulation of the intestine and other internal organs has been completed the duodenum should be investigated if there are evidences of retroperitoneal hematoma, emphysema or a green spot on the parietal peritoneum. The location of the lower horizontal part of the duodenum on the
LURJE A. DUODENAL RUPTURES. Arch Surg. 1938;37(5):808-810. doi:10.1001/archsurg.1938.01200050114009