Duodenal haematoma occurs in children with bicycle injuries

doi:10.1136/bmj.323.7315.754

BMJ 2001;323:754 ( 29 September )

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Duodenal haematoma occurs in children with bicycle injuries

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EDITOR $---$ Closed duodenal injury is a good topic to highlight as a lesson of the week. Surgical injuries to the upper abdomenare a fairly rare childhood injury, and few doctors will diagnosethem with the necessary speed.¹ Lam et al remind us to examinethe paediatric abdomen carefully and frequently after blunt traumaand not to rely too heavily onimaging.

One other type of intra-abdominal damage caused by handlebar injury is not highlighted in this paper. The first and thirdparts of the duodenum may be crushed between the handlebar andthe lumbar spine, causing rupture of the subserosal blood vesselsand resulting in a slowly expanding intramural haematoma.²The child may be relatively free of symptoms until the haematomacauses complete obstruction of the duodenal lumen; as a result,the diagnosis is oftendelayed.

Important clues to the diagnosis include the history of upper abdominal trauma, . . . [Full text of this article]

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Lesson of the week: Delayed presentation of handlebar injuries in children: Jimmy P H Lam, Graeme J Eunson, Fraser D Munro, and John D Orr
BMJ 2001 322: 1288-1289. [Extract] [Full Text] [PDF]

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