blunt duodenal trauma

[Mathias Kalkum]

Learned experts,

today I saw a 17 y/o male who suffered blunt abdominal trauma 6 days 
ago. On day five he went to another hospital due to mild abdominal pain 
and nausea, from where he was send to us because "our US is not working".

On admission, mild tenderness mid right abdomen, nausea, bilirubin 
slightly elevated (3.5), no free fluid. On ward for observation.

When I met him first time this morning he still had mild tenderness 
right mid abdomen and a palpable mass. Sono showed large retroperitoneal 
formation in the upper to mid right abdomen, cava obstruted, mild 
congestion of right urether, massiv fluid in stomach and first part of 
duodenum. CT showed large, at least partially intramural haematoma of 
the duodenum *behind* the papilla. Still haemodynamically stable and 
feeling quite well.

What now?

Mathias