Abdomen / Pelvis for Thursday, April 10th, 2025

History

8 year old female with history of abdominal pain and chronic constipation presenting with worsening pain and emesis after recent intervention.

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Question

What is the diagnosis?

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Correct answer

Duodenal hematoma

Discussion

Duodenal hematoma is uncommon in the pediatric population according to textbooks and journal articles (1). However, it is the most commonly reported intramural hematoma in the GI tract (2). Location of hematoma within the duodenum may differ based on etiology. Hematoma secondary to blunt trauma (accidental or non-accidental) is typically seen in the mid D3 portion while hematoma secondary to pancreatitis is most commonly seen in the distal duodenum near the ligament of Treitz (3).  Duodenal hematoma can be seen after upper endoscopy, frequently in the duodenal bulb or proximal duodenum. The imaging findings are most evident on CT, although modalities without ionizing radiation such as ultrasound are preferred as first line imaging in the pediatric population (4). Early diagnosis enables conservative management and minimizes complications including duodenal obstruction (5, 6).

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References

• Wang JY, Ma CJ, Tsai HL, Wu DC, Chen CY, Huang TJ, Hsieh JS. Intramural duodenal hematoma and hemoperitoneum in anticoagulant therapy following upper gastrointestinal endoscopy. Medical Principles and Practice. 2006 Oct 13;15(6):453-5.
• Lorente‐Ramos RM, Santiago‐Hernando A, Del Valle‐Sanz Y, Arjonilla‐Lopez A. Sonographic diagnosis of intramural duodenal hematomas. Journal of clinical ultrasound. 1999 May;27(4):213-6.
• Kunin JR, Korobkin M, Ellis JH, Francis IR, Kane NM, Siegel SE. Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma. AJR. American journal of roentgenology. 1993 Jun;160(6):1221-3.
• Shilyansky J, Pearl RH, Kreller M, Sena LM, Babyn PS. Diagnosis and management of duodenal injuries in children. Journal of pediatric surgery. 1997 Jun 1;32(6):880-6.
• Veldt BJ, Haringsma J, Florijn KW, Kuipers EJ. Coumarin-induced intramural hematoma of the duodenum: case report and review of the literature. Scandinavian journal of gastroenterology. 2011 Mar 1;46(3):376-9.
• Han SJ, Tsai CC, Mo LR, Tseng LJ, Yau MP. Laparoscopic finding and imaging of the iatrogenic duodenal intramural hematoma. Hepato-gastroenterology. 1997 Jan 1;44(13):139-42.