Spontaneous Intramural Duodenal Hematoma: Pancreatitis, Obstructive Jaundice, and Upper Intestinal Obstruction

Case report: two cases of spontaneous intramural duodenal hematoma associated with pancreatitis

Intramural duodenal hematoma (IDH) is a rare entity and is generally associated with trauma. Spontaneous (nontraumatic) intramural duodenal hematoma is associated with bleeding disorders, anticoagulation therapy, alcoholism, pancreatitis, tumours  and duodenal ulcers. We report two cases of spontaneous intramural duodenal hematoma in middle-aged men who subsequently developed pancreatitis. The underlying pathophysiology is still unclear. In the cases described, it is not clear whether the intramural duodenal hematoma contributed to the development of pancreatitis or pancreatitis has contributed to the development of IDH.

Endoscopic management of intramural spontaneous duodenal hematoma: A case report

BACKGROUND

Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding.

CASE SUMMARY

The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States).

CONCLUSION

Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.

A case of spontaneous intramural duodenal hematoma in a young African man: Imaging findings

Intramural duodenal hematoma has been reported as a rare condition first described by McLauchlan in 1838. It is now thought to be an uncommon condition due to the increase in the number of reported cases in the medical literature. It has been reported to usually occur secondary to blunt trauma mainly in young men and children, with 82% of the patients being younger than 30 years. Association between spontaneous intramural duodenal hematoma and coagulopathy, coagulating drugs, endoscopic procedures, acute pancreatitis, and pancreatic malignancy has been made. We present the case of a 35-year-old African male lumberjack with no known previous history of trauma, risk factors, or associated predisposing condition that presented to our facility with acute abdominal pain and vomiting and diagnosed as spontaneous intramural duodenal haematoma on CT scan and MR imaging with a complete resolution on conservative management.

Conservative management of traumatic acute intramural hematoma of duodenal 2nd and 3rd portion: A case report and review of literature

Traumatic intramural duodenal hematoma (IMDH) is a rare disease occurring usually in children. The treatment modality of traumatic IMDH varies according to clinical manifestations. We had a case of a young man who had traumatic IMDH and treated nonoperatively. He had 3 weeks of conservative care and has been discharged, with follow up abdominal CT scan showing complete resolution of the hematoma. In conclusion, patient with traumatic acute intramural hematoma of duodenal 2nd and 3rd portion have excellent clinical outcomes with conservative therapy.

Clinical features and outcomes in spontaneous intramural small bowel hematoma: Cohort study and literature review

Background/Aims

Spontaneous intramural small bowel hematoma (SISBH) is an extremely rare complication of anticoagulant or antiplatelet therapy. We assessed the clinical characteristics and outcomes of patients with SISBH according to the anatomical location of the hematoma.

Methods

From January 2003 to February 2016, medical records for all patients hospitalized for SISBH at 2 tertiary referral hospitals were retrospectively reviewed. The primary outcome was requirement for surgery.

Results

A total of 37 patients were enrolled. The mean age was 74.1 years. Among them, 33 patients (89.2%) were taking anticoagulant and/or antiplatelet agents. Duodenal intramural hematoma was detected in 4 patients (10.8%), jejunal in 16 (43.2%), and ileal in 17 (45.9%). Compared to jejunal and ileal involvement, duodenal intramural hematoma was significantly associated with high Charlson comorbidity index and low levels of white blood cells, hemoglobin, and platelets in the blood. SISBH in the duodenum was related to thrombocytopenia in 3 patients following systemic chemotherapy for malignancy. All patients with SISBH showed clinical improvement with conservative therapy. Mean length of hospital stay was 9.35 days. Independent predictors of a hospital stay of more than 7 days were body weight less than 60 kg (odds ratio [OR], 12.213; 95% confidence interval [CI], 1.755–84.998; P=0.011) and a history of cerebrovascular accidents (OR, 6.667; 95% CI, 1.121–39.650; P=0.037).

Conclusions

Compared to jejunal and ileal involvement, thrombocytopenia may result in spontaneous duodenal intramural hematoma among patients who are treated with systemic chemotherapy for malignancies. Patients with SISBH have excellent clinical outcomes with conservative therapy regardless of the anatomical location of the hematoma.