図１〜図３の↑は肝損傷であるが周囲に腹水，血腫やextravasationを認めない．図４〜図１２の液貯留（※）は後腹膜内と思われ，後腹膜臓器の損傷を示唆する．胃前庭部から十二指腸，上部空腸までの走行は図７の1〜図７の17までとなる．図４の7〜図７の14は十二指腸の走行と一致し，低濃度な部分とやや高濃度な部分が混在し不均一で血腫と推測する．図５と図６の▲は血腫により頭側へ圧排され扁平化し幅が拡がった十二指腸であり，十二指腸壁内血腫と診断する．図Aは48時間後の胃十二指腸造影で，十二指腸壁の圧排像と狭窄を示している（△）．右側十二指腸に限定された壁内血腫であったが，2日間で中央より左側へ拡大している．保存的に治療し，7日目に水分摂取，11日目から食事摂取が可能となった．図B〜図Dは19日目のCTで，血腫（↑）はかなり縮小している．

文献考察：十二指腸壁内血腫
１）Jurkovich GJ，Bulger EM．34．Duodenum and Pancreas，In．Trauma．4th ed．709-734．2004 Appleton ＆ Lange，Connecticut，USA．
要旨：小児に多いが成人でも鈍的外傷後発生する．1/3は外傷後48時間以上経ってから発症する．十二指腸造影でcoiled spring（ぜんまい）signまたはstacked（積み重ねた）coin signを呈する．保存的治療が主流で，経鼻胃管を挿入し高カロリー輸液を始める．経鼻胃管からの排液量が減少しないなら1週間後に十二指腸造影を行う．2週間経っても閉塞所見が改善しないなら手術の適応である．

２）J Trauma. 2003 Apr;54(4):640-5; discussion 645-6.
Blunt duodenal injuries in children.
Desai KM, Dorward IG, Minkes RK, Dillon PA.

BACKGROUND: Duodenal injury secondary to blunt trauma continues to pose a diagnostic challenge. The purpose of this study is to evaluate the cause, radiologic findings, and management of duodenal injuries from a Level I pediatric trauma center. METHODS: A retrospective review of our trauma registry from 1990 to 2000 identified 24 children with blunt duodenal injuries. Clinical and radiographic findings and management strategies were assessed and compared in children with duodenal hematomas and perforations. RESULTS: The majority of injuries were secondary to motor vehicle collisions. Pancreatic (42%) injuries were most commonly associated with duodenal trauma. With the exception of hematocrit level, initial clinical and laboratory findings were similar between groups. Of the 19 (79%) with duodenal hematomas, computed tomographic (CT) scan alone identified 15 and the remaining 4 were confirmed by duodenography. Incision and drainage of a hematoma was performed in two children. Duodenal perforation was identified in five (21%) children. Extraluminal air by CT scan was present in three of five children with perforation; however, none had extravasation of contrast. Four (80%) children with perforations underwent primary repair and one (20%) required segmental resection. CONCLUSION: CT scanning remains a valuable tool in the diagnosis of blunt duodenal injuries in children. Although extravasation of oral contrast was not beneficial, the presence of extraluminal air was highly suggestive of perforation. The vast majority of hematomas were successfully managed nonoperatively, and duodenorrhaphy was safe and effective therapy for perforations.PMID: 12707524
追記：外傷性十二指腸壁内血腫19例中17例が保存的治療で治癒した．経口摂取可能までの日数は2〜29日（平均9.3日），平均入院日数は16.4日であった．