A Case of Pancreatitis-Induced Intramural Duodenal Hematoma

Lee, Jong Seok; Kwon, Oh Young; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

Abstract

Intramural duodenal hematoma (IDH) usually develops following blunt abdominal trauma. Spontaneous IDH is a rare condition that could be caused by anticoagulant therapy, coagulation disorders, or duodenal endoscopy. Here we report a patient with pancreatitis who developed IDH and gastrointestinal obstruction. A 37-year-old man presented to the emergency department with a six-hour history of persistent localized pain over the epigastric area that radiated to his back and was associated with vomiting. A computed tomography scan with multiplanar reformation revealed pancreatitis and collapse of the duodenal loop that was deviated upward by a hematoma. Pancreatitis-induced IDH was diagnosed and conservative treatment was initiated. On the fourth day of his hospital stay, the patient developed unbearable abdominal pain associated with symptoms of small bowel obstruction. During laparotomy, the hematoma was evacuated and gastrojejunostomy was performed to relieve the duodenal obstruction. Pancreatitis-induced IDH is a rare condition causing gastrointestinal obstruction and should be differentiated from other conditions that result in retroperitoneal hematoma.