IS Case 88: Intramural Duodenal Hematoma
Imaging Sciences URMC 2008
Publication Date: 2009-05-20
History
Patient is a 2-year-old male with abdominal pain, nausea and vomiting after abdominal trauma.
Findings
Large intramural duodenal hematoma.
Diagnosis
Intramural Duodenal Hematoma
Discussion
Intramural duodenal hematoma is a rare cause of intestinal obstruction. Trauma accounts for 70% of cases and non-accidental trauma accounts for the majority of those under four years of age. The second and third portion of the duodenum is usually affected from duodenal compression against the spine as it courses across the midline. These patients also may sustain pancreatic injury resulting in pancreatitis. Occasionally, the insult may be so minor that the child might not recall the incident. Duodenal hematoma is more common in boys since this population is involved in more trauma. Other causes include Henoch-Schönlein purpura, coagulopathies, or iatrogenic from endoscopy.
Best imaged with CT, intramural duodenal hematoma usually shows eccentric bowel wall thickening with a high attenuation lesion. A functional obstruction can be detected with an upper GI study. Other modalities such as MRI and ultrasound can also be used to image.
Differential diagnosis includes enteric duplication cyst, tumors including lymphoma, GIST, adenoma, or lipoma, and rarely malrotation, Crohn’s disease, annular pancreas, or web duodenitis/ulcer.
Typical symptoms of intramural duodenal hematoma include nausea, vomiting, and abdominal pain. It is usually treated with supportive care but percutaneous drainage or surgery are performed if there is perforation or if severe symptoms persist. Prognosis is excellent.
References
- Iuchtman M, Steiner T, Faierman T, Breitgand A, Bartal G. Post-traumatic intramural duodenal hematoma in children. Isr Med Assoc J. 2006 Feb;8(2):95-7. [PMID: 16544730]
- Desai KM, Dorward IG, Minkes RK, Dillon PA. Blunt duodenal injuries in children. J Trauma. 2003 Apr;54(4):640-5; discussion 645-6. [PMID: 12707524]
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