Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma.

OBJECTIVE: Traumatic duodenal perforation requires emergent surgery, whereas duodenal hematoma can often be treated nonsurgically. We assessed the CT findings in patients with blunt duodenal trauma to determine if CT can be used to differentiate these two duodenal injuries. MATERIAL AND METHODS: Seven consecutive patients with blunt duodenal trauma (three with perforation, four with hematoma) who underwent CT as part of their initial diagnostic evaluation were included in the study. All three perforations and one of four hematomas were surgically proved. Diagnoses of duodenal hematoma in the other three patients were based on typical features on upper gastrointestinal studies and complete resolution of clinical findings after conservative treatment. The CT scans were retrospectively reviewed without knowledge of the specific type of duodenal injury, and the findings were correlated with the results of the gastrointestinal studies and surgical findings. RESULTS: CT showed extraluminal gas or extravasated oral contrast material or both in the right anterior pararenal space in all three patients with duodenal perforation and in none of the patients with duodenal hematoma. Thickening of the duodenal wall and fluid in the right anterior pararenal space were seen in both groups of patients. CONCLUSION: Although the number of patients in the study was small, the results suggest that CT may be useful in differentiating duodenal perforation from hematoma without perforation. Extraluminal gas or extravasated oral contrast material or both were seen in the right anterior pararenal space in all three patients who had perforation and in none of the patients who had hematoma alone.

Congenital prostatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration.

Congenital prostatic cysts are relatively uncommon and rarely symptomatic. We describe a 24-year-old man who presented with a 2-month history of anejaculation accompanied with bilateral epididymal pain. Transrectal ultrasonography of the prostate revealed a large midline prostatic cyst and bilateral dilatation of the seminal vesicles. Transrectal aspiration of the cyst resulted in return of antegrade ejaculation and resolution of epididymal pain.