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Traumatic Isolated Intramural Duodenal Hematoma Causing Intestinal Obstruction.

D'Arpa F, Orlando G, Tutino R, Salamone G, Battaglia EO, Gulotta G - ACG Case Rep J (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.

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After 5 days, repeat EGD revealed a massive parietal hematoma in the posterior wall of the duodenal bulb... Two weeks later, an endoscopic ultrasound to evaluate the possibility of endoscopic drainage showed a delimitation of the lesion below the third layer of the duodenal wall, surrounded by the remaining layers (Figure 3)... Three weeks later, EGD showed complete reabsorption of the hematoma; a soft oral diet was started (Figure 4)... Prompt diagnosis and adequate therapy of intramural duodenal hematoma (IDH) are crucial, as delay in diagnosis and treatment beyond 24 hours increases mortality from 11% to 40%... During the 1970s, the majority of patients who presented with a duodenal hematoma were treated with surgical therapy; today, the literature supports the conservative management of IDH, reserving operative treatment for persistent occlusions or progressive growth of hematomas., Conservative treatment comprises gastric decompression, parenteral nutrition, and antibiotic prophylaxis... Any coagulation disorders should be excluded or treated., We propose an endoscopic follow-up to monitor the grade of duodenal obstruction and the resolution of the lesion, and endoscopic ultrasound for drainage if needed... The outcome of conservative treatment is good, with complete resolution of IDH within 2–3 weeks... Orlando and EO Battaglia designed the manuscript, and acquired, analyzed, and interpreted data... Salamone acquired, analyzed, and interpreted data... Gaspare approved the final version of the manuscript... Financial disclosure: None to report... Informed consent was obtained for this case report.

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EUS performed on hospital day 14 showing a healthy pancreas and a round lesion with a mixed echo-structure (8 cm × 5.6 cm × 6 cm DAP) extending from the gastric antrum to the second duodenal portion, localized below the third layer of the duodenal wall and surrounded by the remaining fourth and fifth layers.
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Figure 3: EUS performed on hospital day 14 showing a healthy pancreas and a round lesion with a mixed echo-structure (8 cm × 5.6 cm × 6 cm DAP) extending from the gastric antrum to the second duodenal portion, localized below the third layer of the duodenal wall and surrounded by the remaining fourth and fifth layers.

Mentions: A 21-year-old man was admitted 36 hours after a blunt abdominal trauma occurred during a sporting competition. He complained of colic epigastric abdominal pain, nausea, and vomiting. He was hemodynamically stable; blood counts and metabolic panel were normal. Abdominal CT showed an intestinal obstruction caused by an 8 × 6 × 11 cm hematoma on the right lateral duodenal wall without signs of active bleeding (Figure 1). He underwent gastric decompression and started total parenteral nutrition and intravenous pump inhibitors. Esophagogastroduodenoscopy (EGD) performed 48 hours after the diagnosis showed an extrinsic compression by a bluish obstruction in the first part of the duodenum resembling an extraparietal hematoma (Figure 2). After 5 days, repeat EGD revealed a massive parietal hematoma in the posterior wall of the duodenal bulb. Two weeks later, an endoscopic ultrasound to evaluate the possibility of endoscopic drainage showed a delimitation of the lesion below the third layer of the duodenal wall, surrounded by the remaining layers (Figure 3). Endoscopic drainage was not performed, and the patient was managed conservatively. Three weeks later, EGD showed complete reabsorption of the hematoma; a soft oral diet was started (Figure 4). On follow-up, the patient was asymptomatic.


Traumatic Isolated Intramural Duodenal Hematoma Causing Intestinal Obstruction.

D'Arpa F, Orlando G, Tutino R, Salamone G, Battaglia EO, Gulotta G - ACG Case Rep J (2015)

EUS performed on hospital day 14 showing a healthy pancreas and a round lesion with a mixed echo-structure (8 cm × 5.6 cm × 6 cm DAP) extending from the gastric antrum to the second duodenal portion, localized below the third layer of the duodenal wall and surrounded by the remaining fourth and fifth layers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508937&req=5

Figure 3: EUS performed on hospital day 14 showing a healthy pancreas and a round lesion with a mixed echo-structure (8 cm × 5.6 cm × 6 cm DAP) extending from the gastric antrum to the second duodenal portion, localized below the third layer of the duodenal wall and surrounded by the remaining fourth and fifth layers.
Mentions: A 21-year-old man was admitted 36 hours after a blunt abdominal trauma occurred during a sporting competition. He complained of colic epigastric abdominal pain, nausea, and vomiting. He was hemodynamically stable; blood counts and metabolic panel were normal. Abdominal CT showed an intestinal obstruction caused by an 8 × 6 × 11 cm hematoma on the right lateral duodenal wall without signs of active bleeding (Figure 1). He underwent gastric decompression and started total parenteral nutrition and intravenous pump inhibitors. Esophagogastroduodenoscopy (EGD) performed 48 hours after the diagnosis showed an extrinsic compression by a bluish obstruction in the first part of the duodenum resembling an extraparietal hematoma (Figure 2). After 5 days, repeat EGD revealed a massive parietal hematoma in the posterior wall of the duodenal bulb. Two weeks later, an endoscopic ultrasound to evaluate the possibility of endoscopic drainage showed a delimitation of the lesion below the third layer of the duodenal wall, surrounded by the remaining layers (Figure 3). Endoscopic drainage was not performed, and the patient was managed conservatively. Three weeks later, EGD showed complete reabsorption of the hematoma; a soft oral diet was started (Figure 4). On follow-up, the patient was asymptomatic.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

After 5 days, repeat EGD revealed a massive parietal hematoma in the posterior wall of the duodenal bulb... Two weeks later, an endoscopic ultrasound to evaluate the possibility of endoscopic drainage showed a delimitation of the lesion below the third layer of the duodenal wall, surrounded by the remaining layers (Figure 3)... Three weeks later, EGD showed complete reabsorption of the hematoma; a soft oral diet was started (Figure 4)... Prompt diagnosis and adequate therapy of intramural duodenal hematoma (IDH) are crucial, as delay in diagnosis and treatment beyond 24 hours increases mortality from 11% to 40%... During the 1970s, the majority of patients who presented with a duodenal hematoma were treated with surgical therapy; today, the literature supports the conservative management of IDH, reserving operative treatment for persistent occlusions or progressive growth of hematomas., Conservative treatment comprises gastric decompression, parenteral nutrition, and antibiotic prophylaxis... Any coagulation disorders should be excluded or treated., We propose an endoscopic follow-up to monitor the grade of duodenal obstruction and the resolution of the lesion, and endoscopic ultrasound for drainage if needed... The outcome of conservative treatment is good, with complete resolution of IDH within 2–3 weeks... Orlando and EO Battaglia designed the manuscript, and acquired, analyzed, and interpreted data... Salamone acquired, analyzed, and interpreted data... Gaspare approved the final version of the manuscript... Financial disclosure: None to report... Informed consent was obtained for this case report.

No MeSH data available.