If bleeding or leakage of duodenal contents occurs in the retroperitoneal signs, and the results of peritoneal lavage may be negative. If bleeding occurs peritoneally, however, there may be signs of peritonitis, and lavage may reveal an elevated amylase or bile count. Additional clues include:
- Ring upper quadrant pain or tenderness:
- Referred pain in the shoulder, back, right groin, or testicles:
- Vomiting:
- Elevated white blood cell count or serum amylase.