A review of the literature and data from all similar cases reported so far are briefly presented and discussed. [ncbi.nlm.nih.gov]

Presentation of Case A 32-year-old woman presented with a 24-hour history of constant dull epigastric pain, nausea and non-bilious vomiting. This was her second similar presentation to the emergency department within 24 hours. [academic.oup.com]

• Easy Bruising

  She is a known patient of Glanzmann's thrombasthenia with a history of recurrent epistaxis and easy skin bruising which was followed up in other hospital. [afrjpaedsurg.org]

  Easy bruising and bleeding problems have been reported in up to 55% of patients. Coagulation studies reveal prolonged bleeding time, factor VIII, XI and XII deficiencies, thrombocytopenia and platelet function defects [ 8 - 14 ]. [omicsonline.org]

• 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]

  Figure 1 A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender. [nejm.org]

  The presentation of patients is usually with abdominal pain, nause and vomiting. [scopemed.org]

• Fever

  To our knowledge, this is the second case of dengue fever complicated with duodenal hematoma reported in literature. Key words: Duodenal haematoma, dengue fever, abdominal mass, upper gastrointestinal bleeding. [scopemed.org]

  She developed post-procedure fever, tachycardia, and abdominal pain and was taken to the operating room for urgent cholecystectomy with intraoperative cholangiogram. [acgcasereports.gi.org]

  The next day, the patient developed fever (38.5℃). His pulse rate, respiratory rate, and blood pressure were 114/min, 18/min, and 90/60 mmHg, respectively. [synapse.koreamed.org]

  However, hematemesis and fever are only occasionally present (15.3–23.1%) [ 6 ]. In this case, the patient presented with abdominal pain, hematemesis, and jaundice. [ncbi.nlm.nih.gov]

• Ecchymosis

  – late finding Grey-Turner’s sign (ecchymosis of the flanks) – late finding *History of risk factors as above Evaluation and Diagnosis 1,3,4,5 Complete Blood Count for anemia Lipase – suggests pancreatic or duodenal injury Urinalysis for hematuria – [emdocs.net]

  […] cephalad located hemorrhage • Pelvic hematomas may compress the bladder causing urinary symptoms • Pancreaticoduodenal hematomas may cause gastric outlet obstruction • Perinephric hematomas may manifest in hematuria • Femoral nerve palsy • Flank and groin ecchymosis [accesssurgery.mhmedical.com]

  There was slight fullness in the submental region extending inferiorly into the midline, but no ecchymosis of the overlying skin (Fig. 1). [docksci.com]

  The lower extremities noted multiple small ecchymosis in various stages of healing. There was normal range of motion in upper and lower extremities, no focal joint pain or effusions noted. [wjgnet.com]

• Surgical Procedure

  Therefore, a surgical procedure was urgently performed. Considering the rarity of its etiology in Korea, we report a case of duodenal intramural hematoma complicated with chronic pancreatitis. [e-ce.org]

  Caldera DL, Nussbaum SR. et aL Multifactorial index of cardiac risk in noncardiac surgical procedures. ‎ Pagina 236 - Chesnut RM, Marshall LF, Klauber MR et al. „The role of secondary brain injury in determining outcome from severe head injury... ‎ [books.google.it]

  In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following: Increased intensity [supercoder.com]

• Cough

  The patient discussed in this report did have significant coughing episodes preceding her intramural haemorrhage. Hence, coughing could have been responsible for the child’s duodenal intramural bleeding. [ispub.com]

  Our study demonstrated there is no association between closed and direct trauma (cough) on tracheal epithelium in the development of tracheal diverticula. Despite the... N. B. [posterng.netkey.at]

  She did not have any cough, chest pain, difficulty breathing, stridor or drooling. On physical examination, she was afebrile. Her speech was fluent without stridor or respiratory distress. [docksci.com]

• Abdominal Pain

  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]

  Figure 1 A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender. [nejm.org]

  The presentation of patients is usually with abdominal pain, nause and vomiting. [scopemed.org]

• 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]

  Duodenal haematoma commonly presents with upper gastrointestinal tract obstruction with abdominal pain and non-bilious vomiting. Other clinical features may include bilious vomiting and obstructive jaundice [ 3, 4 ]. [academic.oup.com]

• Nausea

  Figure 1 A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender. [nejm.org]

  A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy. The patient's international normalized ratio value was 2.7. [ncbi.nlm.nih.gov]

• Epigastric Pain

  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]

  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. [jstage.jst.go.jp]

  So patients commonly present with epigastric pain and vomiting due to the failure to pass gastric secretions past the obstructing hematoma. [knowmedge.com]

  A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. [academic.oup.com]

  After two weeks, the patient returned to hospital due to colic epigastric pain with elevated lipase and amylase levels in the blood tests. Computerized tomography (CT) identified a hypoechoic, homogenous mass in the pancreatic head ( Fig. 1 ). [scielo.isciii.es]

• Contusion

  […] superior mesenteric artery Rupture of duodenum Direct blow with compression or shearing forces against the spine Closed loop blowout from deceleration Midline transection of the pancreas Contact with steering wheel or handlebars Rapid deceleration Renal contusion [emdocs.net]

  […] pneumomediastinum ) 2 in penetrating trauma, extra-luminal free gas is not specific to bowel perforation; extra-luminal contrast media/bowel contents leak and a wound track extending to bowel is considered the most sensitive; wall thickening/mesenteric contusion [radiopaedia.org]

  Pancreatic and Duodenal Trauma Pancreatic trauma · key feature is the presence or absence of ductal injury · overall mortality 20% (mostly from associated injury) Grading I minor contusion or lac - NO ductal injury II major contusion or lac - NO ductal [gog.net.nz]

  Some key points identified were: The injury was very uncommon, with one child per hospital per year at best 90% had tenderness or marks of some sort on their abdomen (seatbelt sign, handlebar mark, other contusions). Free air was not universal. [thetraumapro.com]

  […] specified disorders of muscle 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes nontraumatic hematoma of muscle ( M79.81 ) Diagnosis Index entries containing back-references to M79.81 : Hematoma (traumatic) (skin surface intact) - see also Contusion [icd10data.com]

• Fracture

  M80.0 Age-related osteoporosis with current pathological fracture M80.00 Age-related osteoporosis with current pathological fracture, unspecified site M80.00XA …… initial encounter for fracture M80.00XD …… subsequent encounter for fracture with routine [icd10data.com]

  avulsion, rupture Pelvic fracture Loss of blood from site of fracture Disruption of pelvic venous plexus History and Physical Exam Findings 1,2,6 Lenk or Wunderlich Triad Pain: Back, groin, flank, abdomen (most common presenting symptom) Palpable mass [emdocs.net]

  […] located, associated with pancreaticoduodenal injuries or major abdominal vascular injury -Zone 2: Flank or perinephric regions, associated with injuries to the genitourinary system or colon -Zone 3: Pelvic location, frequently associated with pelvic fractures [accesssurgery.mhmedical.com]

  Risk Factors Predictive of Pelvic Fracture 20 High-risk Clinical Findings GCS < 14 Positive urinalysis Pelvic tenderness Pelvic laceration Pelvic abrasion Abdominal pain/tenderness Femur fracture High-risk Mechanism of Injury Unrestrained motor vehicle [ahcmedia.com]

  Etiology Blunt abdominal trauma Most frequently caused by m otor vehicle accidents leading to liver and spleen injury Also caused by falls from high heights ;, domestic violence, and sport-related trauma Other causes Left-sided thoracic trauma with fractures [amboss.com]

• Irritability

  On the eighth hospital day, abdominal pain suddenly became worse and peritoneal-irritation signs were observed. Therefore, a surgical procedure was urgently performed. [e-ce.org]

  This is caused by psoas muscle irritation and spasm from retroperitoneal soiling by the duodenal leak. Loss of the psoas shadow on the right. Hard to see on this xray, but the left psoas shadow is visible, the right is not. [regionstraumapro.com]

  Prominent behavioural problems are clumsiness, fidgety, irritability [ 31 ]. Eye anomalies, especially strabismus and refractive errors, are common. Coloboma is occasional [ 9, 32 ]. Hearing loss can occur [ 8 - 10, 33 ]. [omicsonline.org]

  […] pulse pressure Tachycardia followed by bradycardia, very weak or absent central pulses, absent peripheral pulses, hypotension (< 70 + 2 × age in years), narrowed pulse pressure (or undetectable diastolic blood pressure) Central nervous system Anxious, irritable [ahcmedia.com]

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]

Approach Considerations Workup of the pediatric trauma patient includes selected laboratory tests and computed tomography (CT). [emedicine.medscape.com]

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]

[…] growth of hematomas. 1,2 Conservative treatment comprises gastric decompression, parenteral nutrition, and antibiotic prophylaxis. [acgcasereports.gi.org]

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]

[…] mesenteric vessels 4, 7 abrupt termination of the mesenteric vessels 7 accumulation ('pooling') of contrast on multiphase imaging suggestive signs 7 mesenteric infilatration: haziness and fat stranding mesenteric hematoma bowel wall thickening Treatment and prognosis [radiopaedia.org]

Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. [westjem.com]

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]

In adult patients, the etiology of hematoma is quite varied. [e-ce.org]

[…] trauma, femoral vascular access, or anticoagulation/antiplatelet medications • Spontaneous retroperitoneal hemorrhage occurs in critically ill patients who are taking anticoagulant or antiplatelet medications, or both • Femoral vascular access common etiology [accesssurgery.mhmedical.com]

Etiology Gunshot wounds (~75%) and stabbings (~20%) are the leading causes of bowel and mesenteric injury from penetrating trauma 8. [radiopaedia.org]

Structures every chapter consistently to include Findings, Imaging Modalities, Clinical Presentation, Pathology, Incidence/Prevalence and Epidemiology, What the Referring Physician Needs to Know, Suggested Readings, and Selected Images to make reference [books.google.com]

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]

Epidemiologic study and clinical aspects of 59 cases observed in Switzerland (1970-1975). Schweiz Med Wochenschr; 1983; 113(17):630-636. 3. Polat C, Dervisoglu A, Guven H, et al.: Anticoagulant-induced intramural intestinal hematoma. [ispub.com]

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]

Key words: acute abdominal pain, computed tomography, intramural hematoma, small bowel, warfarin Advertisement Journal of Molecular Pathophysiology SUBMIT YOUR ARTICLE NOW [scopemed.org]

However, it is difficult to explain the true pathophysiology. [ncbi.nlm.nih.gov]

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]

Monitoring of patients on oral anticoagulants can prevent the occurrence of SIDH and avoid its complications which can be fatal. Shiozawa K, Watanabe M, Igarashi Y, et al. [latunisiemedicale.com]

How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis. PLoS One. 20149(3):e92922. Article | PubMed Anderson MA, Fisher L, Jain R, et al. Complications of ERCP. [acgcasereports.gi.org]

However, complex duodenal injuries may require diversion to allow healing of the duodenal repair and prevent complications. Such repairs involve pyloric exclusion and gastrojejunostomy, omental patch and feeding jejunostomy. [westjem.com]