Spontaneous intramural duodenal hematoma in a young woman

Summary: Non-traumatic spontaneous intramural duodenal hematoma is a rare cause of proximal gastrointestinal obstruction which may present with hemorrhage, jaundice and pancreatitis. In this case report we present a case of spontaneous duodenal hematoma in a 28-year-old female with a history of acute pancreatitis, admitted to hospital for convulsive upper abdominal pain with vomiting as suspected pancreatitis. An MRI examination of the abdomen confi rmed intraluminal bleeding into the duodenum. Following supportive therapy the clinical symptoms spontaneously subsided and laboratory parameters improved. Due to early dia gnosis and therapy the patient had a good outcome, without requiring surgery. Repeated imaging showed hematoma resorption. Key words: abdominal pain – vomitus – duodenal hematoma – hemorrhage

Large Duodenal Hematoma Causing an Ileus after an Endoscopic Duodenal Biopsy in a 6-Year-Old Child: A Case Report

Intramural duodenal hematoma (IDH) in children is a rare complication after esophagogastroduodenoscopy. It is commonly described in patients with additional disorders or risk factors, such as coagulopathy. We present a case of a previously healthy 6-year-old boy with a large obstructing intramural duodenal hematoma and concomitant pancreatitis after an elective esophagogastroduodenoscopy. The patient presented with typical symptoms of an IDH, such as abdominal pain and distension, nausea and vomiting. IDH was diagnosed using ultrasound and magnetic resonance imaging examination. Conservative management with gastric decompression using a nasogastric feeding tube, bowel rest, total parenteral nutrition and analgesia was performed. After three weeks, the patient was discharged from the hospital without any complaints. Interventional management of IDH in pediatric patients with a lack of response to conservative therapy or complicating IDH should be discussed in an interdisciplinary team.

Hematoma duodenal intramural post biopsia endoscópica: una complicación inusual. Reporte de un caso pediátrico

The intramural duodenal hematoma is a rare but well-known collateral complication after an endoscopic biopsy. It is more frequent after abdominal trauma or therapeutic endoscopy and even more in anticoagulant-treated patients or those with coagulation disorders. Clinical presentation consists of the symptoms and the signs of the intestinal obstruction, the pancreatitis and the conjugated hyperbilirubinemia. We report a pediatric case of a five-year-old female patient who was being checked for celiac disease. Without known previous bleeding or coagulation disorders, she presented a intramural duodenal hematoma with pancreatitis as a complication of the endoscopic biopsy procedure. A summary of the symptomatology and the signs, the diagnosis, the conservative treatment and evolution is described and also a reminder to paediatric endoscopists to be aware that this unusual complication can occur. This case presents the possibility that an intramural duodenal hematoma can be a complication of a duodenal endoscopic biopsy in patients with no coagulations disorders. This hematoma subsided with a non-surgical treatment (conservative), assisted by the joint work of a pediatric gastroenterologist and surgeon.