図４の十二指腸水平部（Du）周辺から図９の十二指腸下方の後腹膜腔に液貯留（△）を認めるが，図５〜図７ではその中にガスが散在（拡大図）することは，腸管内容物の腸管外漏出を意味し，十二指腸水平部の後腹膜腔穿孔と診断できる．J：空腸．十二指腸造影で造影剤の漏出を認め（図A：↑），手術で十二指腸水平部の破裂（約2/3周）を確認し（（図B：▲），閉鎖・空腸漿膜パッチ・胃瘻造設術が施行された．

文献考察：十二指腸造影は意外と診断率が低い．sensitivity 54% and specificity 98%．
J Trauma. 2001 Oct;51(4):648-51.
Role of duodenography in the diagnosis of blunt duodenal injuries.
Timaran CH, Daley BJ, Enderson BL.

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