Korean J Gastroenterol.  2009 May;53(5):311-314. 10.4166/kjg.2009.53.5.311.

A Case of Intramural Duodenal Hematoma Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding

• Song MK
• Shin JB
• Park HN
• Kim EJ
• Jeong KC
• Kim DH
• Chung JB
• Kim DY

• KMID: 1767691
• DOI: http://doi.org/10.4166/kjg.2009.53.5.311

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.

Keyword

Intramural duodenal hematoma; Therapeutic endoscopy; Acute pancreatitis

MeSH Terms

Acute Disease
Adult
Diagnosis, Differential
Duodenal Diseases/*diagnosis/pathology/surgery
Duodenal Ulcer/*complications
Hematoma/*diagnosis/pathology/surgery
*Hemostasis, Endoscopic
Humans
Male
Pancreatitis/complications/*diagnosis
Peptic Ulcer Hemorrhage/*therapy
Postoperative Complications
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Endoscopic findings. (A) Adherent blood clot was observed in the duodenal bulb. (B) After removal of blood clot, a stigmata of recent bleeding was exposed on the base of ulcer.

• 

  Fig. 2. Abdominal CT scan findings. (A) A hematoma which was developed in the wall of duodenal 2nd and 3rd portion extended to the abdominal cavity. Common bile duct was dilated. (B) Pancreatic swelling with per-ipancreatic fat infiltration was noted.

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  Fig. 3. Follow-up abdominal CT finding. The size of intraperitoneal hematoma was markedly decreased.

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