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Kojimahara S, Kanazawa M, Tominaga K, Masuyama S, Matsumoto K, Watanabe S, Yamamiya A, Sugaya T, Goda K, Irisawa A. Symptomatic duodenal intramural hematoma caused by weight training: a report of two cases. Clin J Gastroenterol 2024:10.1007/s12328-024-01970-7. [PMID: 38619759 DOI: 10.1007/s12328-024-01970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Symptoms of traumatic duodenal intramural hematoma, a rare disease caused by trauma, blood disease, or antithrombotic therapy, can include abdominal pain. Case 1 is that of a 35-year-old man at a gym who dropped a 100 kg barbell on his abdomen. It was diagnosed as a duodenal obstruction caused by a traumatic intestinal wall hematoma. In Case 2, a 16-year-old male adolescent performing deadlift training at a gym had subsequent abdominal pain. It was diagnosed as intestinal wall hematoma. Both patients improved with conservative treatment. Malignancy is sometimes suspected from imaging findings. Detailed patient history and imaging studies can avoid unnecessary surgery.
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Affiliation(s)
- Shunsuke Kojimahara
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Satoshi Masuyama
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shoko Watanabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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2
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Budimir I, Žulec M, Eljuga K, Židak M, Lisek V. Spontaneous gastric hematoma as a rare cause of acute abdomen: A case report. World J Clin Cases 2023; 11:8551-8556. [PMID: 38188220 PMCID: PMC10768510 DOI: 10.12998/wjcc.v11.i36.8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause. Coagulopathies are the most frequent cause of gastric hematomas. However, other causes include amyloidosis, pancreatitis, visceral vascular aneurysms, endoscopy complications and others. The pathophysiology of spontaneous gastric hematoma is not completely understood. However, it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen. The rarity of this condition increases the challenge of diagnosis, and there is no standard treatment protocol. CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male. He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk. There was no history of trauma, anticoagulant medications or endoscopy procedures. His hemoglobin and hematocrit levels were slightly lower than normal. Multi-slice computed tomography, ultrasound and endoscopy confirmed a gastric intramural hematoma. We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding. The patient responded well, and there were no unexpected events. At the 3-mo follow-up, the ultrasound examination revealed complete regression of the hematoma. CONCLUSION After reviewing the literature and our experience, we recommend that more of these cases should be treated conservatively. The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.
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Affiliation(s)
- Ivan Budimir
- Department for Plastic and Reconstructive Surgery, University Hospital Dubrava, Zagreb 10000, Croatia
- Zagreb School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Mirna Žulec
- Department of Nursing, Catholic University of Croatia, Zagreb 10000, Croatia
| | - Ksenija Eljuga
- Department of Nursing, Bjelovar University of Applied Sciences, Bjelovar 43000, Croatia
| | - Marcel Židak
- Department of Surgery, University of Zagreb, Dubrava University Hospital, Zagreb 10000, Croatia
| | - Valentino Lisek
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb 10000, Croatia
- Doctoral Study of Biomolecular Sciences, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
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3
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Cheema BS, Hashimoto Y. Needle-knife incision and drainage of duodenal intramural hematoma relieving duodenal and biliary obstruction. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:374-378. [PMID: 37719945 PMCID: PMC10500266 DOI: 10.1016/j.vgie.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Case presentation.
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Affiliation(s)
| | - Yusuke Hashimoto
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Florida Health, Jacksonville, Florida
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4
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Duodenal Injuries. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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5
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Zerti HM, Saleem MS, Khan YI, Iqbal Z, Ninalowo H. Small Bowel Obstruction: A Rare Presentation of the Inferior Pancreaticoduodenal Artery Pseudoaneurysm Bleed. Cureus 2021; 13:e16943. [PMID: 34513511 PMCID: PMC8418819 DOI: 10.7759/cureus.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.
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Affiliation(s)
- Hasan M Zerti
- Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, USA
| | | | | | - Zaid Iqbal
- Internal Medicine, Wright Cen, Scranton, USA
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6
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Yeo JH, Terez C, Shapiro M, Merchant A. Warfarin Poisoning and Blunt Abdominal Trauma: A Rare Cause of Small Bowel Obstruction. Cureus 2021; 13:e13603. [PMID: 33816002 PMCID: PMC8009056 DOI: 10.7759/cureus.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
Intestinal intramural hematomas are a rare complication of blunt abdominal trauma in the setting of anticoagulation. A 52-year-old male presented to our surgical service with high-grade small bowel obstruction secondary to an extensive small bowel intramural hematoma requiring resection. The patient sustained a blunt abdominal assault several days earlier and workup revealed severe coagulopathy likely secondary to overexposure to a warfarin-based substance. Few cases have been reported on coagulopathic traumatic small bowel hematomas causing small bowel obstruction. Current literature suggests non-operative management can be used safely; however, operative intervention is warranted if there are signs of ischemia or perforation. This case highlights the importance of a high index of suspicion, thorough investigation, and prompt intervention to avoid significant morbidity in small bowel obstruction secondary to intramural traumatic hematoma.
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Affiliation(s)
- Jane H Yeo
- General Surgery, Rutgers New Jersey Medical School, Newark, USA
| | - Claire Terez
- Surgery, Rutgers New Jersey Medical School, Newark, USA
| | | | - Aziz Merchant
- Surgery, Rutgers New Jersey Medical School, Newark, USA
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7
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A Case of Gastric Intramural Hematoma Caused by Anisakis Infection. Case Rep Gastrointest Med 2020; 2020:9260318. [PMID: 32685220 PMCID: PMC7336193 DOI: 10.1155/2020/9260318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022] Open
Abstract
A sixty-year-old lady admitted complaining of epigastric pain and hematemesis. On admission, esophagogastroduodenoscopic examination revealed ruptured intramural hematoma on the antrum of stomach. Eight days later, follow-up EGD showed improving ruptured intramural hematoma and one anisakis larva. Therefore, the gastric intramural hematoma was considered to be caused by anisakis infection. She recovered after ten days of conservative treatment.
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8
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Delayed Intramural Duodenal Hematoma After a Simple Diagnostic Endoscopic Ultrasonography Fine-Needle Aspiration Procedure. ACG Case Rep J 2019; 6:e00279. [PMID: 32309476 PMCID: PMC7145211 DOI: 10.14309/crj.0000000000000279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022] Open
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9
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Niehues SM, Denecke T, Bassir C, Hamm B, Haas M. Intramural duodenal hematoma: clinical course and imaging findings. Acta Radiol Open 2019; 8:2058460119836256. [PMID: 31007947 PMCID: PMC6456848 DOI: 10.1177/2058460119836256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/04/2019] [Indexed: 01/17/2023] Open
Abstract
Background Intramural duodenal hematoma is a rare condition. Different imaging
modalities are at hand for diagnosis. Purpose To identify patients with intramural duodenal hematoma and report imaging
findings and clinical courses. Material and Methods Typical imaging patterns using ultrasound, computed tomography, and magnetic
resonance imaging were carried out on 10 patients. Results The mean patient age was 7.5 years. The average disease duration was 13
months. Clinical signs of improvement were observed within 16 days. Residues
were still detectable at long-term follow-up. Conclusion For patients with intramural duodenal wall hematoma, diagnosis should be
considered early. Typical imaging findings should be known to ensure optimal
treatment.
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Affiliation(s)
- Stefan M Niehues
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Bassir
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Samra M, Al-Mouradi T, Berkelhammer C. Gastric Outlet Obstruction due to Intramural Duodenal Hematoma after Endoscopic Biopsy: Possible Therapeutic Role of Endoscopic Dilation. Case Rep Gastroenterol 2018; 12:692-698. [PMID: 30631254 PMCID: PMC6323396 DOI: 10.1159/000494967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/26/2018] [Indexed: 12/29/2022] Open
Abstract
Intramural duodenal hematoma (IDH) is an extremely rare complication after endoscopic biopsy. It typically presents with symptoms due to duodenal obstruction, which include abdominal pain and bilious vomiting. The hematoma may also expand and cause ampullary compression leading to pancreatitis and cholestasis. Computed tomography scan and abdominal ultrasound are the most common diagnostic modalities. Treatment is usually conservative, with bowel rest, nasogastric suctioning and total parenteral nutrition. Refractory cases have been described, requiring endoscopic therapy or surgical drainage. We describe a 28-year-old healthy male who presented with acute abdominal pain a few hours after a routine esophagogastrodudenoscopy with biopsies was performed. Following an otherwise uneventful endoscopy, he developed a gastric outlet obstruction and pancreatitis secondary to an IDH. The patient was managed conservatively. Resolution of his gastric outlet obstruction occurred immediately after gentle passage of the endoscope through the narrowed duodenal lumen.
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Affiliation(s)
- Mahmud Samra
- *Mahmud Samra, MD, Department of Internal Medicine, Advocate Christ Medical Center, 4440 W 95th St., Oak Lawn, IL 60453 (USA), E-Mail
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11
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Irisarri Garde R, Vila Costas JJ. Duodenal hematoma caused by endoscopic hemostatic procedures (sclerotherapy). REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:666. [PMID: 28689427 DOI: 10.17235/reed.2017.4883/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Endoscopic hemostatic procedures such as local injection of epinephrine are commonly used for the treatment of bleeding ulcers. Although the risks are usually considered to be minimal, there are reports describing that duodenal intramural hematomas may develop as a complication after endoscopy especially in patients susceptible to hemorrhage such as those with anticoagulants therapy or blood dyscrasia.
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12
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Padalkar M, Savage M, Cohen EB. SMALL INTESTINAL INTRAMURAL HEMATOMA SECONDARY TO A MIGRATING WIRE FOREIGN BODY IN A DOG. Vet Radiol Ultrasound 2017; 59:E61-E65. [PMID: 28233373 DOI: 10.1111/vru.12485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
A 12-year-old spayed female Labrador retriever was presented for a 5-day history of vomiting and inappetence. Radiographic findings included poor peritoneal serosal contrast, segmental small intestinal dilation, and multiple linear, metal opaque, intestinal and peritoneal wire foreign bodies. Sonographic findings included septated, hypoechoic, mural expansion of the distal duodenum and jejunum; and an intramural, thin, linear hyperechogenicity with distal acoustic shadowing consistent with a foreign body. Exploratory laparotomy was performed with resection of the affected distal duodenum and proximal jejunum. Histopathology of the excised segment confirmed an intramural hematoma. This case represents an uncommon complication of migrating wire foreign bodies.
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Affiliation(s)
| | - Mason Savage
- BluePearl Veterinary Partners Atlanta, 455 Abernathy Rd NE, Atlanta, GA, 30328
| | - Eli B Cohen
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607
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13
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Spontaneous Intramural Duodenal Hematoma: Pancreatitis, Obstructive Jaundice, and Upper Intestinal Obstruction. Case Rep Surg 2016; 2016:5321081. [PMID: 27891286 PMCID: PMC5116499 DOI: 10.1155/2016/5321081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Abstract
Nontraumatic intramural duodenal hematoma can cause upper gastrointestinal tract obstruction, upper gastrointestinal hemorrhage, jaundice, and pancreatitis and may be present in patients with normal coagulation. However the pathogenesis of the condition and its relationship with acute pancreatitis remain unknown. We present a case of spontaneous intramural duodenal hematoma and a case of successful nonoperative treatments.
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14
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Ng SNHN, Tan HJ, Keh CHL. A belly of blood: A case report describing surgical intervention in a gastric intramural haematoma precipitated by therapeutic endoscopy in an anticoagulated patient. Int J Surg Case Rep 2016; 26:65-8. [PMID: 27455112 PMCID: PMC4961227 DOI: 10.1016/j.ijscr.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 02/07/2023] Open
Abstract
Gastric intramural hematoma, "intramural dissection" or "false aneurysm", is a rare and dangerous condition which may be more broadly classified as a spectrum of acute gastric mucosal injury. It is postulated that disruption of the mucosa and blood vessels within the submucosal layer results in dissection of the muscularis propria from the mucosa, with eventual clot formation. While a majority of cases resolve with conservative management, we describe a successfully managed case requiring surgical intervention. Progression of the haematoma was documented both endoscopically and surgically in an elderly anticoagulated patient who suffered a complication of therapeutic endoscopic intervention. A review of the literature is presented.
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Affiliation(s)
| | - Hiang Jin Tan
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore.
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15
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Poyrazoglu Y, Duman K, Harlak A. Review of Pancreaticoduodenal Trauma with a Case Report. Indian J Surg 2016; 78:209-13. [PMID: 27358516 DOI: 10.1007/s12262-016-1479-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/30/2016] [Indexed: 12/12/2022] Open
Abstract
Complex anatomical relation of the duodenum, pancreas, biliary tract, and major vessels plays to obscure pancreaticoduodenal injuries. Causes of pancreaticoduodenal injuries are blunt trauma (traffic accidents, sport injuries) in 25 % of cases and penetrating abdominal injuries (stab wounds and firearm injuries) in 75 % of cases. Duodenal injuries are reported to occur in 0.5 to 5 % of all abdominal trauma cases and are observed in 11 % of abdominal firearm wounds, 1.6 % of abdominal stab wounds, and 6 % of blunt trauma. Retroperitoneal and deep abdominal localization of duodenum as an organ contribute to the difficulty in diagnosis and treatment. There are three important major points regarding treatment of duodenal injuries: (1) operation timing and decision, (2) Intraoperative detection, and (3) post-operative care. Therefore, it is difficult to diagnose and treat duodenal trauma. We would like to present a 21-year-old male patient with pancreaticoduodenal injury who presented to our emergency service after firearm injury to his abdomen and discuss his treatment with a short review of related literature.
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Affiliation(s)
- Yavuz Poyrazoglu
- Department of General Surgery, Mevki Military Hospital, Ankara, Turkey
| | - Kazim Duman
- Department of General Surgery, Elazig Military Hospital, Elazig, Turkey
| | - Ali Harlak
- Department of War Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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16
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A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma. Case Rep Gastrointest Med 2015; 2015:201675. [PMID: 26697240 PMCID: PMC4677192 DOI: 10.1155/2015/201675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022] Open
Abstract
Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.
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17
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WITHDRAWN: A belly of blood: A rare case describing surgical intervention in a gastric intramural haematoma precipitated by therapeutic endoscopy in an anticoagulated patient. Int J Surg Case Rep 2015. [DOI: 10.1016/j.ijscr.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Huang WC, Lee CH, Suk FM. Esophagogastroduodenal pneumatosis with subsequent pneumoporta and intramural duodenal hematoma after endoscopic hemostasis: a case report. BMC Gastroenterol 2015; 15:121. [PMID: 26408186 PMCID: PMC4583844 DOI: 10.1186/s12876-015-0351-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophagogastroduodenal pneumatosis is the presence of air in esophagus, stomach, and duodenum simultaneously, which have never been described in the literature. Intramural duodenal hematoma (IDH) rarely occurs after endoscopic intervention. The diagnosis and treatment in both conditions are great challenge in daily practice. CASE PRESENTATION A 70-year-old male patient, who had been taking warfarin for artificial valve replacement, developed IDH and esophagogastroduodenal pneumatosis after endoscopic hemostasis for duodenal ulcer bleeding. Initially, he had abdominal pain, gastrointestinal bleeding and hypotension. Later, he was found to have acute pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin also ensued. The intramural duodenal hematoma and critical condition resolved spontaneously after conservative medical treatment. CONCLUSION Based on this case report, we suggest that intramural duodenal hematoma should be considered if a patient has the tetrad of pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin after an endoscopic intervention. Those patients could be treated conservatively. But, surgery should be considered if the diseases progress or complications persist.
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Affiliation(s)
- Wei-Cheng Huang
- Divisions of Gastroenterology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing Long Road, Taipei, 116, Taiwan.
| | - Chih-Hsin Lee
- Divisions of Pulmonology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Fat-Moon Suk
- Divisions of Gastroenterology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing Long Road, Taipei, 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Abstract
The patient was a 43-year-old man admitted to the hospital with intermittent epigastric pain and vomiting, without any evidence of trauma. Blood tests showed elevated lipase/amylase levels. Abdominal computed tomography (CT) revealed pancreatitis complicated by an intramural duodenal hematoma (IDH). He was conservatively treated, and one month after admission, follow-up panendoscopy showed normal duodenal mucosa without luminal narrowing. Non-traumatic IDH is typically associated with coagulation abnormalities. Abdominal CT is an excellent tool for diagnosis in cases of acute abdomen. However, the pathogenesis of and relationship between IDH and pancreatitis remain unknown.
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Affiliation(s)
- Chia-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital; 2. Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan
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20
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Dibra A, Këlliçi S, Çeliku E, Draçini X, Maturo A, Çeliku E. Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review. G Chir 2015; 36:29-31. [PMID: 25827667 PMCID: PMC4396664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.
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21
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García Santos E, Soto Sánchez A, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: Review of the literature. Cir Esp 2014; 93:68-74. [PMID: 25443151 DOI: 10.1016/j.ciresp.2014.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 01/10/2023]
Abstract
Duodenal injuries constitute a challenge to the Trauma Surgeon, mainly due to their retroperitoneal location. When identified, they present associated with other abdominal injuries. Consequently, they have an increased morbidity and mortality. At best estimates, duodenal lesions occur in 4.3% of all patients with abdominal injuries, ranging from 3.7% to 5%, and because of their anatomical proximity to other organs, they are rarely an isolated injury. The aim of this paper is to present a concise description of the anatomy, diagnosis, surgical management and treatment of complications of duodenal trauma, and an analysis of complications and mortality rates of duodenal injuries based on a 46-year review of the literature.
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Affiliation(s)
- Esther García Santos
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York, EE. UU
| | - Ana Soto Sánchez
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York, EE. UU
| | - Juan M Verde
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York, EE. UU
| | - Corrado P Marini
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York, EE. UU
| | - Juan A Asensio
- Division of Trauma Surgery and Critical Care, Department of Surgery, Creighton University, Omaha, Nebraska, EE. UU
| | - Patrizio Petrone
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, New York, EE. UU..
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22
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Osman M, Mantor C, O'Connor J. Duodenal and retroperitoneal hematoma after upper gastrointestinal endoscopy: First presentation of a child with Hemophilia B. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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Köseoğlu H, Solakoğlu T, Atalay R, Bolat AD, Akin E, Yürekli ÖT, Büyükaşik NŞ, Ersoy O. Anticoagulant-induced intramural duodenal haematoma presenting with upper-gastrointestinal haemorrhage. Arab J Gastroenterol 2013; 14:180-2. [DOI: 10.1016/j.ajg.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022]
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24
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Abdel Samie A, Sun R, Huber A, Höpfner W, Theilmann L. Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series. Med Klin Intensivmed Notfmed 2012; 108:144-8. [PMID: 23135686 DOI: 10.1007/s00063-012-0184-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 09/11/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
Spontaneous small-bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum, and occur in patients who receive excessive anticoagulation with phenprocoumon/warfarin or who have additional risk factors for bleeding. We report three cases of intramural small-bowel hematoma, all complications of treatment with phenprocoumon, which nowadays is used extensively for therapeutic and prophylactic purposes. Diagnosis can be readily attained by sonography and confirmed using computed tomography. Early diagnosis is crucial because most patients can be treated successfully without surgery. Based on this experience and data from the literature, conservative treatment is recommended for intramural intestinal hematomas, when other complications needing laparotomy have been excluded.
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25
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Abdel Samie A, Theilmann L. Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy. Expert Rev Gastroenterol Hepatol 2012; 6:553-8; quiz 559. [PMID: 23061706 DOI: 10.1586/egh.12.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding. Diagnosis can be readily identified with sonography and confirmed with computed tomography. Early diagnosis is crucial as most patients can be treated successfully without surgery. Conservative treatment is recommended for intramural intestinal hematomas, when other associated complications needing laparotomy have been excluded.
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Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
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26
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Grasshof C, Wolf A, Neuwirth F, Posovszky C. Intramural duodenal haematoma after endoscopic biopsy: case report and review of the literature. Case Rep Gastroenterol 2012; 6:5-14. [PMID: 22379465 PMCID: PMC3290028 DOI: 10.1159/000336022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The development of intramural duodenal haematoma (IDH) after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia.
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Affiliation(s)
- Claudia Grasshof
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics and Adolescent Medicine, Ulm, Germany
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27
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Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol 2010; 2:283-8. [PMID: 21160669 PMCID: PMC2998857 DOI: 10.4329/wjr.v2.i7.283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/01/2010] [Accepted: 06/08/2010] [Indexed: 02/06/2023] Open
Abstract
Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonography and endoscopy, and it was complicated by acute pancreatitis. The lesions resolved with conservative management. We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis. In our patient, acute pancreatitis occurred concurrently with hematoma, probably due to obstruction of the duodenal papilla, or compression of the pancreas caused by the hematoma. The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.
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28
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Heng HG, Huang A, Baird DK, Mitsui I, Parnell NK. Imaging diagnosis--spontaneous intramural canine duodenal hematoma. Vet Radiol Ultrasound 2010; 51:178-81. [PMID: 20402407 DOI: 10.1111/j.1740-8261.2009.01648.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 9-year-old neutered female Pug with a 2-week history of pancreatitis was presented for dyspnea, icterus, and intractable vomiting. Sonographically, the gallbladder, intrahepatic bile ducts, and common bile duct were distended. The pancreas was hypoechoic with hyperechoic peripancreatic fat. A mildly heterogeneous intramural mass was present in the muscularis layer of the descending duodenum. A presumptive diagnosis of pancreatitis and smooth muscle tumor of the duodenum leading to common bile duct obstruction was made. The dog died despite supportive care. Necropsy examination confirmed the presence of pancreatitis and an intramural duodenal hematoma.
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Affiliation(s)
- Hock Gan Heng
- Department of Veterinary Clinical Sciences and Veterinary Teaching Hospital, Purdue University, 625, Harrison Street, West Lafayette, IN 47907, USA.
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29
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Yeung VHW, Chao NSY, Leung MWY, Kwok WK. An unusual cause of intestinal obstruction in an adolescent: a case report and management review. Pediatr Rep 2009; 1:e8. [PMID: 21589824 PMCID: PMC3096030 DOI: 10.4081/pr.2009.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 10/26/2009] [Indexed: 12/01/2022] Open
Abstract
A 15-year-old boy presented with intestinal obstruction two weeks following a blunt abdominal trauma. He had progressive bilious vomiting without abdominal distension or peritonitis. The contrast computed tomography (CT) scan of the abdomen provided the definitive diagnosis: there was an obstructing duodenal hematoma, which might have been slowly progressing or have arisen from secondary hemorrhage after the initial injury. The boy remained stable over a ten-day period of conservative treatment, and his obstructive symptoms and signs were resolved completely. A follow-up CT scan of the abdomen (16 days after admission) showed an almost complete resolution of the hematoma. Delayed duodenal hematoma causing intestinal obstruction has been reported rarely in previous literature. Occasionally a significant secondary hemorrhage resulting in intestinal obstruction can become life threatening. Clinical follow-up is paramount after initial recovery. Although conservative treatment suffices in most cases, the surgeon should be wary of the need for definitive surgical intervention if there is evidence of ongoing acute hemorrhage or of the obstructing hematoma failing to resolve. Laparoscopic drainage of the hematoma provides optimistic results for patients failing conservative management.
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Affiliation(s)
- Victor Hip-Wo Yeung
- Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Hong Kong
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30
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Song MK, Shin JB, Park HN, Kim EJ, Jeong KC, Kim DH, Chung JB, Kim DY. [A case of intramural duodenal hematoma accompanied by acute pancreatitis following endoscopic hemostasis for duodenal ulcer bleeding]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 53:311-4. [PMID: 19458468 DOI: 10.4166/kjg.2009.53.5.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
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Affiliation(s)
- Min Keun Song
- Department of Internal Medicine, National Health Insurance Ilsan Hospital, Goyang, Korea
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31
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Sirvain S, Crepeau T, Garrido JF, Watteau N, Niang B, Hallé O. Syndrome occlusif et hémorragique révélant un hématome duodénal intramural iatrogène. ACTA ACUST UNITED AC 2008; 32:611-3. [DOI: 10.1016/j.gcb.2008.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Borsaru AD, Nandurkar D. Intramural duodenal haematoma presenting as a complication after endoscopic biopsy. ACTA ACUST UNITED AC 2007; 51:378-80. [PMID: 17635478 DOI: 10.1111/j.1440-1673.2007.01692.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intramural duodenal haematoma is an uncommon lesion, usually a complication of blunt abdominal trauma in children and young adults. We present a case of intramural duodenal haematoma following endoscopic biopsy, which caused partial duodenal obstruction and pancreatitis and resolved with conservative management.
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Affiliation(s)
- A D Borsaru
- Department of Diagnostic Imaging, Monash Medical Centre, Melbourne, Victoria, Australia
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33
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Sugai K, Kajiwara E, Mochizuki Y, Noma E, Nakashima J, Uchimura K, Sadoshima S. Intramural duodenal hematoma after endoscopic therapy for a bleeding duodenal ulcer in a patient with liver cirrhosis. Intern Med 2005; 44:954-7. [PMID: 16258210 DOI: 10.2169/internalmedicine.44.954] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of intestinal obstruction due to intramural hematoma of the duodenum following therapeutic endoscopy for a bleeding duodenal ulcer in a patient with liver cirrhosis. A 44-year-old man was admitted to our hospital with severe epigastralgia, nausea and tarry stool. Two years previously he had undergone endoscopic sclerotherapy for esophageal varices caused by alcoholic liver cirrhosis. Endoscopy revealed an open ulcer with a bleeding vessel in the duodenal bulb, and sclerotherapy was performed by clipping the vessel and injecting 20 ml of 0.2% epinephrine. His platelet count was 3.5x10(4)/mul. Twelve hours later, he again developed epigastralgia and hypotension. Emergency computed tomography and ultrasonography revealed an intramural hematoma, 15x18 cm in diameter, at the dorsal and lateral duodenum. Endoscopy and upper gastrointestinal series revealed severe stenosis of the duodenal lumen caused by intramural hematoma. He received parenteral feeding for 22 days and within 8 weeks the hematoma was gradually absorbed using conservative management. Intramural duodenal hematoma may be diagnosed as a complication of the endoscopic procedure in a patient with a bleeding tendency, such as liver cirrhosis.
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Affiliation(s)
- Kyoko Sugai
- Department of Internal Medicine, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan
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34
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Faria J, Pessoa R, Hudson M, Vitoi S, Villela O, Torres J, Paula MD, Bemvindo A. Hematoma intramural duodenal como complicação de terapia anticoagulante com Warfarin: relato de caso e revisão da literatura. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000600016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Relatamos o caso de uma paciente em terapia anticoagulante oral com Warfarin, apresentando obstrução intestinal aguda. A tomografia computadorizada revelou hematoma intramural duodenal. O tratamento baseou-se na correção das provas de coagulação e medidas expectantes. Este caso ilustra o valor da tomografia computadorizada e da abordagem conservadora nos pacientes em terapia anticoagulante com obstrução aguda do intestino delgado.
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Affiliation(s)
| | | | | | | | - Ovídio Villela
- Hospital Márcio Cunha; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
| | - José Torres
- Hospital Márcio Cunha; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
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35
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Lloyd GM, Sutton CD, Marshall LJ, Jameson JS. Case of duodenal haematoma treated with ultrasound guided drainage. ANZ J Surg 2004; 74:500-1. [PMID: 15191497 DOI: 10.1111/j.1445-1433.2004.03045.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Duodenal haematoma usually occurs secondary to blunt abdominal trauma(1), although more recently it has been recognized as a complication of endoscopic duodenal biopsy(2). The two established management strategies are to treat conservatively until resolution of the haematoma occurs or to surgically evacuate the haematoma. We present a case of duodenal haematoma that was successfully treated by ultrasound guided drainage when no improvement occurred with conservative treatment.
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Affiliation(s)
- Geraint M Lloyd
- Department of Surgery, University Hospitals of Leicester, Glenfield Hospital NHS Trust, Leicester, United Kingdom
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36
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Shinozaki S, Yamamoto H, Kita H, Yano T, Miyata T, Sunada K, Sekine Y, Kuno A, Onishi N, Iwamoto M, Sasaki A, Ido K, Sugano K. Direct observation with double-balloon enteroscopy of an intestinal intramural hematoma resulting in anticoagulant ileus. Dig Dis Sci 2004; 49:902-5. [PMID: 15309875 DOI: 10.1023/b:ddas.0000034546.01824.ff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
In the case presented here, we have succeeded in describing the endoscopic findings of anticoagulant ileus and evaluated the degree of bleeding as well as ischemia through endoscopic observation. We have demonstrated that enteroscopy using the double-balloon method is a useful diagnostic tool in the evaluation of a patient suspected to have anticoagulant ileus.
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Affiliation(s)
- Satoshi Shinozaki
- Department of Internal Medicine, Division of Gastroenterology, Jichi Medical School, Tochigi, Japan
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37
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Luccas GC, Lobato AC, Menezes FH. Superior Mesenteric Artery Syndrome: An Uncommon Complication of Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2004; 18:250-3. [PMID: 15253266 DOI: 10.1007/s10016-003-0085-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The superior mesenteric artery syndrome (SMAS) is an uncommon finding, especially when occurring after open abdominal aortic aneurysm (AAA) repair. Very few cases have been previously reported in the literature. The underlying anatomic mechanism as well as a better way to manage this complication remains controversial. We report a case of well-documented duodenum obstruction occurring after an elective, uneventful open AAA repair in an 83-year-old white male. The patient was initially discharged from hospital on the fifth postoperative (PO) day but was readmitted on the seventh PO day with suspicion of intestinal obstruction caused either by adhesions or extrinsic pressure by a retroperitoneal hematoma. A laparotomy carried out on the 10th PO day was unremarkable and the patient continued vomiting until a left lateral decubitus positioning was assumed. The patient was discharged home on the 19th PO day and has remained well since.
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Affiliation(s)
- George C Luccas
- Department of Vascular Surgery, Campinas Medical Center, São Paulo, Brazil.
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38
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Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol 2002; 179:1389-94. [PMID: 12438021 DOI: 10.2214/ajr.179.6.1791389] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to review the imaging findings and outcomes of patients with nontraumatic spontaneous intramural small-bowel hematoma. MATERIALS AND METHODS We retrospectively reviewed the records and radiologic studies of 13 patients with known intramural small-bowel hemorrhage. RESULTS The mean age at presentation was 64 years. Sixty-two percent of patients had warfarin toxicity. The diagnosis was evident on CT performed in all patients. Small-bowel obstruction was present in 85% of patients, and biliary obstruction was present in 8%. A single hematoma was present in 85% of patients, and multiple hematomas were present in 15%. The jejunum was the most common site of the hematoma (69%), followed by the ileum (38%) and duodenum (23%). The hematoma extended into the cecum in 15% of patients. The estimated average length of the hematoma was 23 cm, and the shortest segment was 8 cm. Resolution of the hematoma was seen on CT as early as 1 week after onset. Eleven patients (85%) with non-extensive hematomas were dismissed from the hospital without any short- or long-term complications (mean follow-up, 35 months). Two patients with extensive hematomas involving more than half the length of the small intestine died. CONCLUSION Spontaneous intramural small-bowel hematoma is rare. It occurs in patients who receive excessive anticoagulation with warfarin or who have some other risk factor for bleeding. CT characteristics include circumferential wall thickening, intramural hyperdensity, luminal narrowing, and intestinal obstruction. Early diagnosis is crucial because most patients are treated nonoperatively with a good outcome.
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Affiliation(s)
- Maher A Abbas
- Department of Surgery, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
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39
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Boudiaf M, Soyer P, Terem C, Pelage JP, Maissiat E, Rymer R. Ct evaluation of small bowel obstruction. Radiographics 2001; 21:613-24. [PMID: 11353110 DOI: 10.1148/radiographics.21.3.g01ma03613] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed.
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Affiliation(s)
- M Boudiaf
- Department of Body and Vascular Imaging, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
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40
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Farhoud S, Stephani SM, Bromberg SH. [Acute pancreatitis due to intramural hematoma of the duodenum by the use of anticoagulants]. ARQUIVOS DE GASTROENTEROLOGIA 2001; 38:53-6. [PMID: 11582964 DOI: 10.1590/s0004-28032001000100010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. OBJECTIVE To present the acquired knowledge with the treatment of these disease. CASE REPORT A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2.0 to 3.0. RESULTS The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission. CONCLUSION It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.
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Affiliation(s)
- S Farhoud
- Gastroenterologia Cirúrgica do Hospital do Servidor Público Estadual-Francisco Morato de Oliveira (HSPE-FMO)
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41
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Takishima T, Hirata M, Kataoka Y, Naito T, Ohwada T, Kakita A. Delayed development of obstructive jaundice and pancreatitis resulting from traumatic intramural hematoma of the duodenum: report of a case requiring deferred laparotomy. THE JOURNAL OF TRAUMA 2000; 49:160-2. [PMID: 10912875 DOI: 10.1097/00005373-200007000-00026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T Takishima
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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42
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Guzman C, Bousvaros A, Buonomo C, Nurko S. Intraduodenal hematoma complicating intestinal biopsy: case reports and review of the literature. Am J Gastroenterol 1998; 93:2547-50. [PMID: 9860424 DOI: 10.1111/j.1572-0241.1998.00716.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report two cases of postbiopsy duodenal hematoma and review 14 additional cases. Duodenal hematoma predominantly occurs in children and presents with abdominal pain, vomiting, and pancreatitis. Upper gastrointestinal series, abdominal ultrasound, and CT scan are useful in visualizing the hematoma. No comparative studies of the usefulness of these techniques are available, but a CT is indicated if perforation is suspected. The treatment is conservative if no perforation is detected, and resolution of symptoms generally occurs within 2 wk.
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Affiliation(s)
- C Guzman
- Combined Program in Pediatric Gastroenterology and Nutrition, and Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA
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43
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Affiliation(s)
- M E Fesenmyer
- Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, USA
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44
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Karjoo M, Luisiri A, Silberstein M, Kane RE. Duodenal hematoma and acute pancreatitis after upper gastrointestinal endoscopy. Gastrointest Endosc 1994; 40:493-5. [PMID: 7926545 DOI: 10.1016/s0016-5107(94)70219-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Karjoo
- Department of Pediatrics, Cardinal Glennon Children's Hospital, St. Louis University Medical Center, Missouri
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45
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MESH Headings
- Duodenum/injuries
- Duodenum/surgery
- Hematoma/etiology
- History, 19th Century
- History, 20th Century
- Humans
- Rupture
- Survival Rate
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/history
- Wounds, Nonpenetrating/mortality
- Wounds, Nonpenetrating/surgery
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/history
- Wounds, Penetrating/mortality
- Wounds, Penetrating/surgery
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Affiliation(s)
- J A Asensio
- Division of Trauma Surgery and Surgical Critical Care, Hahnemann University School of Medicine, Philadelphia, Pennsylvania
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46
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Lamont PM, Clarke PJ, Collin J. Duodenal obstruction after abdominal aortic aneurysm repair. EUROPEAN JOURNAL OF VASCULAR SURGERY 1992; 6:107-10. [PMID: 1532557 DOI: 10.1016/s0950-821x(05)80107-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Duodenal obstruction is a rare post-operative complication of abdominal aortic aneurysm repair. Out of only four previously reported cases, two were post-mortem findings and the other two were managed surgically by gastro-jejunostomy and duodeno-jejunostomy, respectively. We present here two further cases of duodenal obstruction after aneurysm repair, one due to intramural haematoma and the other due to the superior mesenteric artery syndrome. Both cases were managed conservatively with parenteral nutrition and an expectant policy, with a successful outcome in each case.
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Affiliation(s)
- P M Lamont
- Oxford Regional Vascular Unit, Nuffield Department of Surgery, Oxford University, John Radcliffe Hospital, U.K
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47
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Aizawa K, Tokuyama H, Yonezawa T, Doi M, Matsuzono Y, Matumoto M, Uragami K, Nishioka S, Yataka I. A case of traumatic intramural hematoma of the duodenum effectively treated with ultrasonically guided aspiration drainage and endoscopic balloon catheter dilation. GASTROENTEROLOGIA JAPONICA 1991; 26:218-23. [PMID: 2040403 DOI: 10.1007/bf02811084] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 52-year-old man was admitted on February 15, 1990, with hiccups and vomiting. He had been well until 13 days before admission when he stumbled and fell when intoxicated, striking his abdomen. A diagnosis of intramural hematoma was made with computerized tomography and sonography of the abdomen after admission, revealing a mass that was intimately related to the duodenum. Treatment of the intramural duodenal hematoma is controversial. However, this case illustrates the ideal situation where conservative management could be applied with total parenteral nutrition, percutaneous aspiration drainage, and endoscopic balloon catheter dilatation of the narrowed lumen of the duodenum. The patient's subsequent course supports the concept of planned conservative management.
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Affiliation(s)
- K Aizawa
- Department of Internal Medicine, Hashimoto Municipal Hospital, Wakayama, Japan
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48
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Abstract
The lethal potential of duodenal trauma relates to the severity of the defect, associated injuries, expedient diagnosis, and adequacy of repair. A high index of suspicion must be used in patients sustaining blunt abdominal trauma. An aggressive approach to penetrating abdominal trauma will detect the majority of duodenal injuries in a timely fashion. The unique anatomic and physiologic characteristics of the duodenum demand careful selection of the operative repair to fit the injury. A classification scheme is reviewed that should help the surgeon select the appropriate procedure from a multitude of choices. Standard postoperative care is required. Adherence to these principles should result in acceptable morbidity and mortality in patients with duodenal injuries.
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Affiliation(s)
- J A Weigelt
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
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49
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Parker GD, Williams JA. Massive intramural duodenal haematoma following blunt abdominal trauma. Case report. AUSTRALASIAN RADIOLOGY 1989; 33:192-4. [PMID: 2775088 DOI: 10.1111/j.1440-1673.1989.tb03273.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a case of a massive intramural duodenal haematoma following blunt abdominal trauma. The value of computed tomography and other imaging modalities is discussed.
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50
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Zinelis SA, Hershenson LM, Ennis MF, Boller M, Ismail-Beigi F. Intramural duodenal hematoma following upper gastrointestinal endoscopic biopsy. Dig Dis Sci 1989; 34:289-91. [PMID: 2644113 DOI: 10.1007/bf01536064] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report a case of a patient who developed an intramural duodenal hematoma after an endoscopic biopsy which caused obstruction of the duodenum with obstructive jaundice and pancreatitis. We speculate the limited mobility of the duodenum and its rich submucosal vascular plexus were the crucial factors.
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Affiliation(s)
- S A Zinelis
- Department of Medicine, Shadyside Hospital, Pittsburg, Pennsylvania 15232
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