A major cause of mortality after a traumatic duodenal rupture in addition to hemorrhage is which of the following?

• A. Spillage of intraluminal contents into the peritoneum
• B. Bowel infarction from ischemia
• C. Inability to digest food/malnutrition
• D. Ileus

Answer: (A)

Spillage of intraluminal contents into the peritoneum from a duodenal rupture drives mortality because once the sterile abdominal space is contaminated with gastric juice, bile, and pancreatic enzymes, chemical irritation quickly evolves into peritonitis and then bacterial infection. This contamination sparks a systemic inflammatory response that can progress to sepsis, shock, and multi-organ failure if not rapidly controlled. The duodenum’s retroperitoneal position can delay recognition, allowing the leaked contents to spread and worsen the inflammatory cascade. While other issues like ischemia, ileus, or malnutrition can occur, they are not the immediate, dominant killers in the acute aftermath—the peril is the rapid onset of peritoneal inflammation and sepsis from the leaked contents.