Ultrasound follow-up in a patient with intestinal obstruction due to post-traumatic intramural duodenal hematoma

Abstract

We report the case of a 7-year-old girl with intestinal obstruction due to post-traumatic intramural duodenal hematoma. She had fallen from the monkey bars the day before presenting to our hospital, and was admitted with signs of abdominal pain, vomiting, and nausea. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a heterogeneous solid mass located within the duodenal wall, compressing the descending part of the duodenum. The inferior vena cava was also compressed by the mass lesion, although no associated symptoms were evident. Based on these findings, the mass lesion was considered to represent intramural hematoma causing intestinal obstruction. She was managed conservatively with total parenteral nutrition. Although CT and MRI are useful for differentiating hematoma from other intestinal tumors, ultrasonography is minimally invasive and easier to perform repeatedly. In case of duodenal hematoma, ultrasonography may be quite helpful for diagnosis and follow-up by monitoring tumor size and characteristics, and the degree of duodenal compression during conservative treatment.

Large Duodenal Hematoma Causing an Ileus after an Endoscopic Duodenal Biopsy in a 6-Year-Old Child: A Case Report

“…Repeated clinical and ultrasound examinations are recommended for follow-ups, which should include the monitoring of IDH size and characteristics, as well as the degree of duodenal compression [19,20,34]. In the majority of patients, the time to IDH resolution ranges from one to three weeks, which is in line with the case presented here [27,34].…”

“…With clinical suspicion of a duodenal hematoma, ultrasound or MRI should be performed to verify the diagnosis and to exclude differential diagnoses, such as a duodenal duplication, abscess, pancreatic pseudocyst or solid tumor [19]. A computed tomography (CT) is also described in several case reports, but MRI is superior due to the lack of ionizing radiation exposure [20] and superior soft-tissue resolution. As in our case, an IDH is mostly located in the first to third parts of the duodenum [21].…”

Coágulos intraluminales en postoperatorio de una hepaticoyeyunostomía: rara complicación para un rápido actuar

“…Se han descrito casos de obstrucción intestinal por hematoma intramural y coágulos intraluminales principalmente en traumas (11,12), bypass gástrico laparoscópico con Y-de-Roux (8) (13-17), obstrucción espontánea como en el caso de un niño de 8 años (18), como complicación de la endoscopia (25). En la Tabla 1 se describen los casos de coágulos intraluminales con sus causas.…”

Endoscopic dilatation as a new technique in managing pediatric duodenal hematoma

“…An upper gastrointestinal series may also aid in identifying the obstructed area; however, a diagnosis cannot be achieved using this method. 6,7 Computed tomography scan remains the gold standard for establishing the diagnosis of DH as heterogeneous attenuation of the duodenal wall may be observed and will aid in ruling out perforation. 6 Recurrent abdominal pain, vomiting, and feeding intolerance are noted in children who exhibit late presentation, as seen in our case.…”