Intramural hematoma of the duodenum

Five new cases of intramural duodenal hematoma are reviewed with 174 cases derived from the literature. Operative therapy with simple evacuation of the hematoma is advocated as the procedure of choice. Bypass procedures and resection should be reserved for selected cases.     

Intramural hematoma of the duodenum. Diagnosis and therapy

Two cases of intramural haematoma of the duodenum caused by injury are examined. The clinical signs were non-specific: vomiting and epigastric pain. The salient features of laboratory tests were leucocytosis and hyperamylasaemia. Radiography of the digestive tract revealed classic bunching of the mucous plicae in the second section of the duodenum in one case and a mark on the gastric antrum together with a clear stretch in the third duodenal section in the other. Surgical examination and drainage of the haematoma was performed in one case while the other was given conservative treatment. Both patients were clinically cured on release from hospital.     

Intramural hematoma of duodenum following endoscopic intestinal biopsy

We present the fourth case to be reported in the literature of intramural hematoma of the duodenum following endoscopic small bowel biopsy. It is the first reported to have been diagnosed by ultrasonography and confirmed by contrast roentgenograms. Conservative treatment was effective in achieving satisfactory resolution of the obstruction within seven days, as evidenced by barium meal examination. The mechanism of trauma, in light of the other cases reported in the literature, is discussed.     

Intramural hematoma of the gastrointestinal tract

Two hundred sixty cases of intestinal intramural hematoma and subsequent bowel obstruction have been reported in the world literature. These cases have been evaluated and seventeen additional cases are reported. Multiple etiologic factors are presented, with trauma and anticoagulant therapy being the most common. Barium x-ray examination is the single most reliable diagnostic study. The mode of therapy for intramural hematoma depends upon thorough evaluation of the patient. Patients on anticoagulant therapy are best treated by observation and cessation of anticoagulants. Should the patient fail to improve or become worse, then surgery may become necessary. When trauma is a factor, prompt operative intervention is indicated.     

Intramural duodenal hematoma in children

An account is given of problems implied in diagnosis of intramural duodenal haematoma, with reference being made to three of the author's patients in childhood. The event is rare and may develop in the wake of slight traumatisation. Conservative treatment is possible. Yet, laparotomy is indicated in dubious situations for surgical removal of extravasation and, possibly, duodenal support.