Following blunt abdominal trauma, A 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is

Duodenal hematomas result from blunt abdominal trauma. They present as a high bowel obstruction with abdominal pain and occasionally a palpable right upper quadrant mass An upper gastrointestinal series is almost always diagnostic with the classic coiled. spring appearance of the second and third portions of the duodenum secondary to the crowding of the valvulae conniventes (circular folds) by the hematoma. Nonsurgical management is the mainstay of therapy because the vast majority of duodenal hematomas resolve spontaneously Simple evacuation of the hematoma is the operative procedure of choice. However, bypass procedures and duodenal resection have been performed for this problem. In patients with duodenal obstruction from the superior mesenteric artery syndrome, the obstruction is usually the result of a marked weight loss and, in conjunction with this, loss of the retropentoneal fat pad that elevates the superior mesenteric artery from the third and fourth portions of the duodenum. Nutritional repletion and replenishment of this fat pad will elevate the artery off the duodenum and relieve the obstruction.