Intramural Duodenal Hematoma after Endoscopic Therapy for a Bleeding Duodenal Ulcer in a Patient with Liver Cirrhosis

Abstract

We report a case of intestinal obstruction due to intramural hematoma of the duodenum following therapeutic endoscopy for a bleeding duodenal ulcer in a patient with liver cirrhosis. A 44-year-old man was admitted to our hospital with severe epigastralgia, nausea and tarry stool.

Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

“…More than half of them were verified after biopsy (9). Most of the patients having intramural hematoma of the duodenum after endoscopic haemostatic procedures had coagulation disorders, thrombocytopenia, liver cirrhosis or a combination of these (6). In all the cases we found epinephrine injections were performed, combined in some of them with ethanolamine injections or vessel clipping.…”

“…According to our knowledge, less than 20 cases of intramural hematoma of the duodenum after biopsy or sclerotherapy are reported (2,6,8). More than half of them were verified after biopsy (9).…”

“…Intramural hematoma is a rare complication of diagnostic or therapeutic endoscopic procedure of the upper digestive tract that has been described in different medical reports in the literature (2,5,6). We report a case of intramural hematoma of the duodenum after endoscopic injections of epinephrine in a young patient without associated evident pathologies.…”

Duodenal Hematoma and Pancreatitis Complicating Endoscopic Intestinal Biopsy in a Boy with Noonan Syndrome

“…Its incidence is 1:1000-2500 live births [13][14][15][16][17][18][19][20][21][22]. Approximately 50% of all NS patient have a mutation in the PTPN11 gene mapping on the long arm of chromosome 12 [23].…”

“…In childhood, intramural hematoma of the duodenum usually results from trauma [15] but may also occur spontaneously in patients with bleeding disorders [3] or who are receiving anticoagulation therapy [4] and can be a rare complication of duodenal endoscopic biopsy [2] or therapeutic injection to bleeding ulcers [16]. Anatomically, the relatively fixed retroperitoneal position of the third portion of duodenum and its adjacency to the lumbar spine make it more prone to shear injury when force is applied [17].…”