Clin Endosc.  2012 Sep;45(3):202-204.

Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

• Lee JY
• Chung JS
• Kim TH

Abstract

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

Keyword

Successful endoscopic decompression; Intramural duodenal hematoma; Gastric outlet obstruction

MeSH Terms

Decompression
Drainage
Duodenal Obstruction
Duodenum
Gastric Outlet Obstruction
Hematoma
Humans
Pancreatitis

Figure

• 

  Fig. 1 Computed tomography findings. (A) The arrow indicates a highly attenuated mass narrowing the lumen and major distension of the stomach. (B) Blank arrow indicates mild pancreatic swelling with peripancreatic infiltration.

• 

  Fig. 2 Endoscopic findings. (A) Tiny erosion on the surface of the duodenal hematoma, suggesting the presence of a fistula between the duodenal lumen and hematoma. (B) Endoscopic decompression for intramural duodenal hematoma through the fistula.

• 

  Fig. 3 Follow-up computed tomography of the abdomen showing a decrease in the mass lesion.

• 

  Fig. 4 Follow-up endoscopy showing the remaining small ulcer on the duodenal bulb.

Reference

1. Sidhu MK, Weinberger E, Healey P. Intramural duodenal hematoma after blunt abdominal trauma. AJR Am J Roentgenol. 1998; 170:38. PMID: 9423594.

2. Dubois J, Guy F, Porcheron J. A pancreatic-induced intramural duodenal hematoma: a case report and literature review. Hepatogastroenterology. 2003; 50:1689–1692. PMID: 14571818.

3. Chong VH, Basir N, Yaakub AB. Acute pancreatitis complicated by jejunal hematoma in a patient on anti-coagulants and anti-platelets. JOP. 2010; 11:262–265. PMID: 20442524.

4. 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; 2:283–288. PMID: 21160669.

5. Simi S, Anoop TM, George KC. Spontaneous intramural duodenal hem-atoma: a rare cause of upper gastrointestinal obstruction. Am J Emerg Med. 2010; 28:642. PMID: 20579571.

6. Bodnár Z, Várvölgyi C, Tóth J, Sápy P, Kakuk G. Intramural duodenal hematoma complicating acute necrotizing pancreatitis. Gastrointest Endosc. 2000; 52:791–793. PMID: 11115923.