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Duodenal Hematoma

Duodenal Haematoma


Presentation

  • A review of the literature and data from all similar cases reported so far are briefly presented and discussed.[ncbi.nlm.nih.gov]
  • The patient presented with abrupt onset of abdominal pain, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • Abstract We report the first case in the English literature of an intramural duodenal hematoma presenting as a complication of Helicobacter pylori-induced peptic ulcer disease.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We present the case of a 21-year-old woman who had undergone an upper gastrointestinal endoscopy for dyspepsia and protracted singultus. Work-up included biopsies.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To report the unusual occurrence of intramural duodenal hematoma in a case on anticoagulant therapy, presenting as a complication of gastrointestinal endoscopy.[ncbi.nlm.nih.gov]
Asymptomatic
  • On follow-up, the patient was asymptomatic. Figure 3.[acgcasereports.gi.org]
  • Asymptomatic at 6 months follow-up. Hanish and Pappas [ 12 ] 2007 1 19 Percutaneous CT guided drainage Discharged day 1 post-procedure. CT 10 days after discharge showed complete resolution.[wjes.biomedcentral.com]
Limited Mobility
  • We speculate the limited mobility of the duodenum and its rich submucosal vascular plexus were the crucial factors.[ncbi.nlm.nih.gov]
Developmental Delay
  • Risk factors include poverty, male gender, young age, previous unexplained or repetitive injuries, an adult male other than the father in the home, and children with physical and developmental delays. 72 While any organ may be injured from abuse, the[ahcmedia.com]
Vomiting
  • Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies. KEYWORDS: Drainage; Duodenum; Hematoma, Intramural[ncbi.nlm.nih.gov]
  • Abstract A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION AND INTERVENTION: A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy.[ncbi.nlm.nih.gov]
  • Abstract The patient was a 43-year-old man admitted to the hospital with intermittent epigastric pain and vomiting, without any evidence of trauma. Blood tests showed elevated lipase/amylase levels.[ncbi.nlm.nih.gov]
  • Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies. KEYWORDS: Drainage; Duodenum; Hematoma, Intramural[ncbi.nlm.nih.gov]
  • Abstract A 21-year-old man was admitted with vomiting and abdominal pain 3 days after sustaining blunt abdominal trauma by being tackled in a game of American football.[ncbi.nlm.nih.gov]
  • The presentation of patients is usually with abdominal pain, nause and vomiting.[scopemed.org]
  • CASE PRESENTATION AND INTERVENTION: A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy.[ncbi.nlm.nih.gov]
Nausea
  • CASE PRESENTATION AND INTERVENTION: A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy.[ncbi.nlm.nih.gov]
  • The patient presented with abrupt onset of abdominal pain, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • A 44-year-old man was admitted to our hospital with severe epigastralgia, nausea and tarry stool. Two years previously he had undergone endoscopic sclerotherapy for esophageal varices caused by alcoholic liver cirrhosis.[ncbi.nlm.nih.gov]
  • She had fallen from the monkey bars the day before presenting to our hospital, and was admitted with signs of abdominal pain, vomiting, and nausea.[ncbi.nlm.nih.gov]
  • Figure 1 A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender.[nejm.org]
Projectile Vomiting
  • The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10 x 5 cm in diameter.[ncbi.nlm.nih.gov]
Persistent Vomiting
  • On day 2, she developed severe upper abdominal pain and persistent vomiting with blood. She was kept nil orally and started on iv fluids and antiemetics.[adc.bmj.com]
Suggestibility
  • We suggest that transcatheter arterial embolization can be a cause of duodenal intramural hematoma, and that percutaneous transhepatic biliary drainage, rather than surgical intervention, can be useful in the treatment of biliary or pancreatic obstruction[ncbi.nlm.nih.gov]
  • Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH.[ncbi.nlm.nih.gov]
  • CONCLUSION: Based on this case report, we suggest that intramural duodenal hematoma should be considered if a patient has the tetrad of pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin after an endoscopic intervention[ncbi.nlm.nih.gov]
  • She was having poor response on Infliximab suggested by increasing blood and mucus in her stool, high faecal calprotectin and positive infliximab antibodies.[adc.bmj.com]
  • A repeat ultrasound on the 4 th post-operative day showed a mass in the second part of the duodenum suggestive of duodenal haematoma.[afrjpaedsurg.org]
Neglect
  • These cases demonstrate the risks of endoscopy, which are not to be neglected even in children without impaired coagulation, and the manner in which ultrasound can provide the correct diagnosis and follow-up. 2014 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Child Abuse & Neglect 2012;36:142–148. Lane WG, Dubowitz H, Langenberg P. Epidemiology of abusive abdominal trauma hospitalizations in United States children. Child Abuse & Neglect 2012;36:142–148. Committee on Trauma, American College of Surgeons.[ahcmedia.com]

Workup

  • His initial laboratory workup revealed hemoglobin 8.1 g/dL, AST 13 u/L, ALT 10 u/L, alkaline phosphatase of 45 u/L, total bilirubin 0.6 mg/dL, and lipase level was of 1322 mg/dL.[ijcasereportsandimages.com]
  • On admission, the patient had stable vital signs and a normal laboratory workup. Gradually his clinical condition deteriorated and a computed tomography scan showed a retroperitoneal haematoma at the level of his duodenum.[ikee.lib.auth.gr]

Treatment

  • The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife.[ncbi.nlm.nih.gov]
  • Abstract A prospective plan for the nonoperative treatment of obstructing intramural duodenal hematoma was developed to (1) promptly establish the diagnosis and rule out transmural leaks by obtaining a contrast roentgenogram on admission and to subsequently[ncbi.nlm.nih.gov]
  • The patient was treated by conservative treatment that included correction of clotting abnormalities, blood transfusion, nasogastric decompression, hydration, and parenteral nutrition support.[ncbi.nlm.nih.gov]
  • The diagnosis and treatment in both conditions are great challenge in daily practice.[ncbi.nlm.nih.gov]
  • Abstract Spontaneous intramural duodenal hematomas are not frequent and generally are related with an anticoagulant treatment. Pancreatic origin has seldom been described and the treatment is always controversial.[ncbi.nlm.nih.gov]

Prognosis

  • With no early perforation due to post-biopsy IDH reported, the prognosis is good and conservative management generally leads to resolution of the symptoms in 2 to 3 weeks.[ncbi.nlm.nih.gov]
  • Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary.[ncbi.nlm.nih.gov]
  • Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively.[jamanetwork.com]

Etiology

  • The main etiology of non-traumatic intramural hematoma of the duodenum in the adult is overdose anticoagulant therapy. Rarer causes include pancreatic disease, blood dyscrasia or vascular collagen disease.[ncbi.nlm.nih.gov]
  • Bicycle handlebar, road accidents and sports trauma are the main etiologic factors in children, but child abuse should be kept in mind. Associated traumatic pancreatitis is common. Gastroduodenal endoscopy may be useful to clarify doubtful cases.[ncbi.nlm.nih.gov]
  • In adult patients, the etiology of hematoma is quite varied.[e-ce.org]
  • Atraumatic splenic rupture (ASR) can occur in diseased (pathologic rupture) or normal spleen (spontaneous rupture). [1, 2, 3] ASR is associated with varied etiologies including, neoplastic, infectious, inflammatory, noninfectious, drug-and treatment-related[tropicalgastro.com]
  • Further molecular studies are at now in process to determine the exact etiology of this correlation. A conservative treatment was sufficient to treat this child successfully.[omicsonline.org]

Epidemiology

  • A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med. ‎[books.google.it]
  • Epidemiology of abusive abdominal trauma hospitalizations in United States children. Child Abuse & Neglect 2012;36:142–148. Lane WG, Dubowitz H, Langenberg P. Epidemiology of abusive abdominal trauma hospitalizations in United States children.[ahcmedia.com]
Sex distribution
Age distribution

Pathophysiology

  • Key words: acute abdominal pain, computed tomography, intramural hematoma, small bowel, warfarin Advertisement Journal of Molecular Pathophysiology SUBMIT YOUR ARTICLE NOW[scopemed.org]
  • Early involvement of a surgeon experienced in the management of traumatic abdominal injuries in children is considered imperative. 7 Pathophysiology It must be remembered that children are not small adults.[ahcmedia.com]

Prevention

  • A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984; 130: 12-15. ‎[books.google.it]
  • A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984; 130: 12-15. ‎ Pagina 73 - Pepe PE. Marini JJ.[books.google.it]
  • Detecting this rare injury requires a high degree of suspicion based on the mechanism of injury and early CT scan ( see Figure 6 ) to prevent a delay in diagnosis and subsequent complications, such as infection. 57 Figure 6.[ahcmedia.com]

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