Solution: If you study the CT images carefully, you will note a couple of pertinent findings. First, there is active extravasation of contrast into the lumen of the second portion of the duodenum. In addition, there is a "picket-fence" appearance to the mucosal folds in the third portion of the duodenum. Bother of these are consistent with an injury to the duodenum with associated hemorrhage. In addition, there is extensive fluid in the adjacent extraperitoneal space with fluid tracking into the anterior pararenal space. Note that this injury is often associated with pancreatic injuries as well, although no definite pancreas injury is identified here. It would be appropriate to do an UGI in this setting and this was done. It confirmed duodenal hematoma with extravasation of contrast consistent with rupture.