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1.
Duodenal haematoma usually occurs secondary to blunt abdominal trauma(1), although more recently it has been recognized as a complication of endoscopic duodenal biopsy(2). The two established management strategies are to treat conservatively until resolution of the haematoma occurs or to surgically evacuate the haematoma. We present a case of duodenal haematoma that was successfully treated by ultrasound guided drainage when no improvement occurred with conservative treatment. 相似文献
2.
Eric I. Jeng Jeffrey Jeng Shanel Bhagwandin Gary J. Merlotti James Doherty 《Injury Extra》2013,44(9):79-80
Trauma is the leading cause of morbidity and mortality in the paediatric population. Following the head and extremities, the abdomen is the third most commonly injured anatomic region in children [1]. We present a case of a massive duodenal haematoma secondary to blunt trauma that was managed nonoperatively. Several cases reports in the literature cite successful nonoperative management of duodenal haematoma by nasogastric decompression, bowel rest, and total parenteral nutrition [4], with resumed eating an average of 16 days after injury [9]. However, if the abdominal pain or obstruction fail to improve and/or resolve with medical management over seven to ten days, complications such as infarction or peritonitis are frequent, and surgical intervention may be required [3]. 相似文献
3.
4.
W Popp 《Zentralblatt für Chirurgie》1987,112(4):242-245
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. 相似文献
5.
P Iván H András P Margit 《Magyar traumatológia, orthopaedia és helyreállító sebészet》1976,19(4):296-300
A rare case of the blunt abdominal injuries--forming a clinical entity--intramural duodenal haematoma is reported. The symptoms of IMDH may appear--non specifically--after a longer interval. The diagnosis is assured in the first place by careful anamnesis and on the basis of the characteristic radiological signs. The treatment may be--depending on the extent of the obstruction--conservative or surgical--in the latter case mostly the evacuation of the haematoma is performed. 相似文献
6.
Claudio Soravia M.D. Terri Berk M.S.S.A. Gregory Haber M.D. Zane Cohen M.D. Steven Gallinger M.D. M.Sc. 《Journal of gastrointestinal surgery》1997,1(5):474-478
Patients with familial adenomatous polyposis (FAP) are at increased risk for the development of periampullary cancer. The
aim of this study was to evaluate the roles of endoscopic and surgical therapy in the management of advanced duodenal polyposis
in FAP. From 1990 to 1995, seventy-four FAP patients were enrolled in a prospective endoscopic surveillance protocol. Among
these, 11 (14.8%) developed advanced duodenal polyposis and one had duodenal adenocarcinoma. Six patients underwent endoscopic
resection of duodenal (n=5) or ampullary adenomas (n=1). The following operations were performed in the remaining six patients:
ampullectomy in four, open polypectomy in one, and a Whipple procedure in one. There was one patient who died of acute pancreatitis
following endoscopic ampullectomy. The patient with invasive duodenal cancer died of local recurrence. Small polyps were observed
at the site of previous resection in all (9 of 9) patients undergoing repeat endoscopy during a mean follow-up of 18 months
(range 4 to 34 months). An endoscopic and local surgical resectional approach to advanced duodenal polyposis in FAP is fraught
with high recurrence rates, although recurrent polyps are small and may be amenable to retreatment in the future. Long-term
follow-up is necessary to prove that deaths from duodenal or ampullary cancer are prevented with this strategy. 相似文献
7.
Spontaneous intramural duodenal haematoma develops mostly as a complication of anticoagulation therapy. Other causes were reported only as case reports. CT diagnostics has some typical features in an intramural haematoma of the small bowel. This is especially hyperdensity of the bowel wall during the first 10 days from the onset of symptoms (30-80 HU), which could contribute to the differentiation from other infiltrative processes. These features are fully expressed only in a certain part of patients. We reported a 54 year-old female treated for epigastric pain. The patient's history, laboratory data, ultrasonography and CT findings resulted in a mistaken diagnosis of acute pancreatitis, necrosis of the pancreatic body with a subsequent development of pancreatic pseudocyst. The CT guided drainage was performed. The correct diagnosis was made one year later--surgical treatment was indicated for clinical signs of GI obstruction and CT findings of pseudocyst recurrence. During the operation, there was a finding of intramural haematoma in the duodenojejunal border. We performed an evacuation of the haematoma and gastroenteroanastomosis. 相似文献
8.
Spontaneous intramural duodenal haematoma (IDH) is an uncommon pathology and it is usually related to anticoagulant therapy. Other causes include various pancreatic diseases, connective tissue disease, peptic ulcer disease and pancreaticoduodenal aneurysm. IDH of pancreatic origin has been infrequently reported. The disease course can be life-threatening and serious complications may occur, including gastric outlet obstruction, duodenal perforation and septicaemia. A case of pancreatic-induced IDH is presented, for which pancreaticoduodenectomy was performed as definitive treatment. In general, medical treatment with continuous nasogastric aspiration and total parenteral nutrition is recommended as initial management strategy. Surgical interventions (evacuation of blood clot or surgical resection) are reserved for patients in whom medical treatment fails or complications occur. 相似文献
9.
Chen-Wang Chang Ming-Jen Chen Shou-Chuan Shih Horng-Yuan Wang Chung-Hsin Tsai Tsang-En Wang Wen-Hsiung Chang 《American journal of surgery》2010,199(6):e77
An intramural duodenal hematoma with duodenal obstruction is usually a complication of blunt abdominal trauma, endoscopic biopsy, or peptic ulcer disease. Possible management strategies include conservative treatment, surgical evacuation, and percutaneous or endoscopic drainage. We report on a 40-year-old man with a remote history of trauma who presented with vomiting for 3 days. At surgery, he was found to have an intramural duodenal hematoma causing obstruction. 相似文献
10.
Duodenal injury following blunt abdominal trauma is uncommon. The severity of injury can vary from
an intramural haematoma to a duodenal rupture with associated transection of the pancreatic duct. A
case of duodenal rupture with avulsion of the ampulla of Vater is presented and discussed. 相似文献
11.
Intestinal obstruction in adults caused by congenital duodenal webs is uncommon. Roentgenographic and endoscopic diagnosis is difficult owing to frequently nonspecific roentgenographic findings and the obliteration of normal pyloric endoscopic anatomy. The ultimate diagnosis of this lesion is likely to be made at the time of cellotomy for suspected obstructing peptic ulcer disease with the observation of an unobstructed pylorus. We studied three recent cases and reviewed the pertinent literature, which demonstrated problems associated with preoperative and surgical diagnosis and management. Diagnosis of duodenal webs should be suspected in all patients with gastric or high duodenal obstruction and investigated by digital duodenal exploration at the time of surgery. 相似文献
12.
Endoscopic retrograde cholecystocholangiopancreatography and subsequent manometry in 1,018 patients with diseases of the biliary tract showed signs of stenosis of the major duodenal stenosis in the absence of concrements in the biliary system in 25 (2.45%) of them. On the basis of the results of such examination and the clinical and laboratory findings, the authors suggest that patients with benign stenosis of the major duodenal papilla should be divided into two groups: Group 1, with compensated stenosis and Group 2, with decompensated stenosis of the major duodenal papilla. Depending on the degree of the stenosis, they suggest the following endoscopic organ-preserving surgical interventions: endoscopic papillomyotomy and sparing endoscopic papillosphincterotomy. 相似文献
13.
Background Benign duodenal tumours are rare and less common than malignant tumours. They comprise a wide variety of pathologies. Schwannoma
is an ectodermal neoplasm arising from the nerve sheath that envelops axons. A duodenal location is extremely rare. Therapy
consists in the radical excision of the tumour. Our aim was to describe a minimally invasive technique used for the excision
of duodenal schwannoma, so that a laparotomy has been avoided.
Methods A laparoscopic operation under general anaesthesia was undertaken with the patient in supine position with the legs abducted.
No macroscopic peritoneal seedling was found. Therefore, a laparoscopic Kocher maneuver was performed. The retroperitoneum
was entered using the harmonic scalpel and the dissection extended beyond the vena cava and the duodenum. The location and
the size of the lesion have been confirmed using an intraoperative endoscopic ultrasound examination. The excision of the
lesion was performed by use the harmonic scalpel. Then, the duodenal wall was sutured by use endoscopic stitches. The resected
lesion was then placed in a retrieval bag and extracted through the port incision. Operating time was 300 min and blood loss
200 ml.
Results The postoperative course was uneventful. Histological findings showed a benign schwannoma.
Conclusions The minimally invasive technique may be a valid alternative to open surgery in the treatment of benign duodenal tumors.
Electronic supplementary material to this article is available at and accessible for authorized users. 相似文献
14.
Isolated duodenal injury in blunt abdominal trauma is unusual. Diagnosis requires a complete exploration of the abdominal cavity. The authors present a rare case of disruption and necrosis of the second duodenum with periampullary duodenal detachment. 相似文献
15.
I Segal A Solomon L O Tim H H Lawson M C Sottomayor 《Suid-Afrikaanse tydskrif vir geneeskunde》1977,52(18):724-727
Thirteen patients with giant duodenal ulcer manifested with a distinct clinical syndrome. The condition has a characteristic clinical, radiological and endoscopic presentation. It is associated with a high mortality when treated medically, and constitutes a definite indication for surgery. The giant duodenal ulcer forms a high proportion of duodenal ulcers in a recently urbanized Black community, and may be one of the dramatic and significant presentations of this disease in the developing countries. 相似文献
16.
外伤性十二指肠损伤的诊断与治疗 总被引:10,自引:0,他引:10
目的 探讨提高十二指肠损伤的早期诊断率和合适的治疗方法。方法 回顾性分析40例十二指肠损伤患者的临床资料。结果 40例中32例(80%)为严重多发伤。致伤原因以挤压伤,撞击伤为主,占82.5%。全部经手术治疗:行十二指肠修补术24例,空肠十二指肠Roux-en-Y吻合术8例,十二指肠改良憩室化手术6例,改良憩室化再简化手术2例,治愈35例,死亡5例,死亡原因为多脏器损伤,创伤性休克及十二指肠瘘,感 相似文献
17.
The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology. 相似文献
18.
Recent experiences with duodenal trauma 总被引:3,自引:0,他引:3
In a 10-year period ending December 1983, 56 patients with duodenal injuries were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. Most injuries consisted of isolated duodenal lacerations or perforations (37), five patients had duodenal hematomas, and 14 patients had injuries involving the duodenum, pancreas, ampulla, and/or common bile duct. Most injuries were successfully managed with suture repair. The Whipple procedure was necessary in five cases. Overall morbidity was 39.2 per cent, but complications directly related to the duodenal injury occurred in only six patients (10.7%). Only three patients died (5.3%). Excellent results can be achieved even with extensive duodenal injuries by the use of careful debridement and primary closure. When injuries to the duodenum are associated with injury to the ampulla of Vater, the head of the pancreas, or the common bile duct, a Whipple procedure is usually necessary. It has not been necessary to employ duodenal bypass or diverticulization. 相似文献
19.
20.
目的 提高十二指肠损伤的诊断与治疗水平。方法 回顾性分析32例十二指肠损伤的临床资料。结果 仅1例术前明确诊断,另3例术前诊断十二指肠损伤可能,其余均手术探查确诊。本组病例均经手术治疗,治愈28例(87.5%),死亡4例(12.5%)。结论 简单而合理的手术方式是治疗十二指肠损伤的重要措施。注重早期诊断。加强术中探查,强调术后引流及营养支持的重要性,可提高治愈率。 相似文献