Rupture duodenal

Gastric rupture is mainly seen in neonates due to acute distention of the stomach, ischemic necrosis associated with perinatal asphyxia and distal obstruction such as annular pancreas (Ibach and Inouye 1965) or duodenal atresia/stenosis. On the other hand, duodenal rupture in neonates is rare. 

At CT the diagnosis of duodenal rupture should be suspected in the presence of free air or contrast medium in the retroperitoneum (adjacent to the duodenum, kidneys, and psoas muscles), free retroperitoneal fluid, mesenteric haematoma, and pancreatic transection (Hofer and Cohen 1989 Brody et al. 2000 Maniatis et al. 2000 Jayaraman et al. 2001). Focal discontinuity of the duodenal wall can be seen occasionally (see Fig. 12.25). 

Pancreatitis, any cause (P-AMY T) Pancreatic trauma (P-AMYT) Biliary tract disease (P-AMYT) - Intestinal obstruction (PtAMYT) Mesenteric infarction (P-Alv4Y(t Perforated peptic ulcer (P-AMYiT) Gastritis, duodenitis (P-AMY ) Ruptured aortic aneurysm Acute appendicitis Peritonitis Trauma... 

Sonomura T, Horihata K et al. (2002) Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration. AJR Am J Roentgenol 181 725-727... 

Similarly, adjacent inflammatory changes such as pancreatitis can cause compromise of vessel wall integrity. Proteolytic degradation can occur if pancreatic enzymes come in contact with arteries. Gastroduodenal and pancreaticoduodenal pseudoaneurysms are especially prone to rupture in the presence of duodenal ulceration, pancreatitis, or pseudocyst formation [6,7]. These should be treated regardless of size. 

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