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Cheema BS, Hashimoto Y. Needle-knife incision and drainage of duodenal intramural hematoma relieving duodenal and biliary obstruction. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:374-378. [PMID: 37719945 PMCID: PMC10500266 DOI: 10.1016/j.vgie.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Video 1Case presentation.
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Affiliation(s)
| | - Yusuke Hashimoto
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Florida Health, Jacksonville, Florida
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2
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El Aidaoui K, Lahlou W, Bourial A, Bouknani N, El Kettani C. Intestinal Spontaneous Intramural Hematoma Secondary to Anticoagulation Therapy: A Case Report. Cureus 2023; 15:e37257. [PMID: 37162778 PMCID: PMC10164366 DOI: 10.7759/cureus.37257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
A common complication of anticoagulation therapy is bleeding, especially in patients receiving long-term vitamin K antagonists. Spontaneous intramural hematoma is a rare etiology among life-threatening major bleeds. An 80-year-old female patient presented with diffuse abdominal pain. Her history included ischemic heart disease and chronic atrial fibrillation treated with 3 mg of acenocoumarol per day. Three days before her admission, she developed diffuse abdominal pain with fecaloid vomiting, bloating, and not passing gas. Palpation of the abdomen revealed asymmetrical distension and pain, with no signs of peritoneal irritation or bleeding. Investigations showed anemia with a hemoglobin level of 9.2 g/dL, a white blood cell count of 14200/mm3, a C-reactive protein of 112.6 mg/L, and a prothrombin time of 75.1 seconds with an international normalized ratio (INR) of 8.5. Abdominal contrast-enhanced computed tomography (CT) showed segmental parietal thickening, luminal narrowing, and partial small bowel obstruction secondary to an intramural jejunum hematoma responsible for a gallbladder occlusion with infiltration of the mesenteric fat in front. The patient recovered two days after conservative treatment. In this case, we report an unusual small bowel intramural hematoma of the jejunum secondary to anticoagulant therapy. Physicians should be aware of this unusual cause of abdominal pain. Early diagnosis may avoid unnecessary surgical exploration.
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Affiliation(s)
- Karim El Aidaoui
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Wahib Lahlou
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Abderrahim Bourial
- Otolaryngology, Head and Neck Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Nawal Bouknani
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Chafik El Kettani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Pérez-Rubio Á, Sebastián-Tomás JC, Navarro-Martínez S, Córcoles MC, Pozo CDD. Intramural duodenal hematoma: diagnosis and management of a rare entity. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2022:S2173-5077(22)00227-7. [DOI: 10.1016/j.cireng.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/05/2022] [Indexed: 02/05/2023]
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Pérez-Rubio Á, Sebastián-Tomás JC, Navarro-Martínez S, Córcoles Córcoles M, Domingo del Pozo C. Hematoma intramural duodenal: diagnóstico y manejo de una entidad infrecuente. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sunnapwar A, Ojili V, Katre R, Shah H, Nagar A. Multimodality imaging of adult gastric emergencies: A pictorial review. Indian J Radiol Imaging 2021; 27:13-22. [PMID: 28515579 PMCID: PMC5385768 DOI: 10.4103/0971-3026.202957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
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Affiliation(s)
- Abhijit Sunnapwar
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rashmi Katre
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hardik Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Arpit Nagar
- Department of Body Imaging, Ohio State University Wexner Medical Center, Ohio, USA
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Amankwa AT, De Graft-Johnson E, Twum KA, Ankomah K. A case of spontaneous intramural duodenal hematoma in a young African man: Imaging findings. Radiol Case Rep 2021; 16:1675-1678. [PMID: 34007382 PMCID: PMC8111469 DOI: 10.1016/j.radcr.2021.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Adu Tutu Amankwa
- Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Kwasi Ankomah
- Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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7
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Imaging of acute gastric emergencies: a case-based review. Clin Imaging 2020; 72:97-113. [PMID: 33221628 DOI: 10.1016/j.clinimag.2020.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022]
Abstract
The stomach is one of the most frequently imaged organs in the body with dedicated and incidental inclusion in chest imaging modalities. Gastric emergencies often present clinically with non-specific abdominal, nausea, and vomiting. As such, imaging plays a critical role in early identification and treatment of a myriad of gastric emergencies. The goal of this paper is to showcase gastric emergencies as they appear on multimodality imaging.
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Niehues SM, Denecke T, Bassir C, Hamm B, Haas M. Intramural duodenal hematoma: clinical course and imaging findings. Acta Radiol Open 2019; 8:2058460119836256. [PMID: 31007947 PMCID: PMC6456848 DOI: 10.1177/2058460119836256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/04/2019] [Indexed: 01/17/2023] Open
Abstract
Background Intramural duodenal hematoma is a rare condition. Different imaging
modalities are at hand for diagnosis. Purpose To identify patients with intramural duodenal hematoma and report imaging
findings and clinical courses. Material and Methods Typical imaging patterns using ultrasound, computed tomography, and magnetic
resonance imaging were carried out on 10 patients. Results The mean patient age was 7.5 years. The average disease duration was 13
months. Clinical signs of improvement were observed within 16 days. Residues
were still detectable at long-term follow-up. Conclusion For patients with intramural duodenal wall hematoma, diagnosis should be
considered early. Typical imaging findings should be known to ensure optimal
treatment.
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Affiliation(s)
- Stefan M Niehues
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Bassir
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Haas
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Mirkov I, Popov Aleksandrov A, Demenesku J, Ninkov M, Mileusnic D, Zolotarevski L, Subota V, Kataranovski D, Kataranovski M. Intestinal toxicity of oral warfarin intake in rats. Food Chem Toxicol 2016; 94:11-8. [PMID: 27181730 DOI: 10.1016/j.fct.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/18/2022]
Abstract
Though warfarin is extensively used in the prevention and treatment of thromboembolic processes in humans, adverse effects of warfarin therapy have been recognized. Intestinal hemorrhage is one of the hazards of anticoagulant therapy, but the mechanisms of warfarin toxicity are virtually unknown. In this work, the effects of 30 days oral warfarin (0.35 mg/l and 3.5 mg/l) intake on rat's gut were examined. Both doses resulted in prolongation of prothrombin time. Systemic effects of higher warfarin dose (increases in plasma AST, proteinuria, hematuria, changes in peripheral blood hematological parameters) were seen. Warfarin intake resulted in histologically evident tissue damage, leukocyte infiltration and intestinal inflammation [increases in myeloperoxidase activity, malondialdehyde content, superoxide dismutase and catalase activity, proinflammatory cytokine (IFN-γ, IL-17) concentrations in intestinal homogenates]. In contrast, suppression of gut-draining mesenteric lymph node (MLN) cell activity [proliferation responsiveness, production of IFN-γ and IL-17 to T lymphocyte mitogen Concanavalin A stimulation] was noted. Inhibition of regulatory cytokine IL-10 production by MLN cells, suggests commitment of MLN to the suppression of all inflammatory activities and creation of the microenvironment which is non-permissive for induction of potentially harmful immune response. These novel findings indicate the need of staying alert for (adverse) effects of warfarin therapy.
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Affiliation(s)
- Ivana Mirkov
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia
| | - Aleksandra Popov Aleksandrov
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia
| | - Jelena Demenesku
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia
| | - Marina Ninkov
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia
| | - Dina Mileusnic
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia
| | - Lidija Zolotarevski
- Institute for Pathology, Military Medical Academy, 17 Crnotravska, 11000 Belgrade, Serbia
| | - Vesna Subota
- Institute for Medical Biochemistry, Military Medical Academy, 17 Crnotravska, 11000 Belgrade, Serbia
| | - Dragan Kataranovski
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia; Institute of Zoology, Faculty of Biology, University of Belgrade, 16 Studentski trg 11000 Belgrade, Serbia
| | - Milena Kataranovski
- Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, 142 Bulevar despota Stefana, 11000 Belgrade, Serbia; Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, 16 Studentski trg, 11000 Belgrade, Serbia.
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Abstract
The patient was a 43-year-old man admitted to the hospital with intermittent epigastric pain and vomiting, without any evidence of trauma. Blood tests showed elevated lipase/amylase levels. Abdominal computed tomography (CT) revealed pancreatitis complicated by an intramural duodenal hematoma (IDH). He was conservatively treated, and one month after admission, follow-up panendoscopy showed normal duodenal mucosa without luminal narrowing. Non-traumatic IDH is typically associated with coagulation abnormalities. Abdominal CT is an excellent tool for diagnosis in cases of acute abdomen. However, the pathogenesis of and relationship between IDH and pancreatitis remain unknown.
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Affiliation(s)
- Chia-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital; 2. Emergency Medicine, College of Medicine, National Yang-Ming University, Taiwan
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Non-traumatic intramural hematomas in patients on anticoagulant therapy: Report of three cases and overview of the literature. Afr J Emerg Med 2014. [DOI: 10.1016/j.afjem.2014.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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12
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Liang JJ, Hart PA. An unusual cause of small bowel obstruction. Gastroenterology 2014; 147:285-6. [PMID: 24976030 DOI: 10.1053/j.gastro.2014.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/21/2014] [Accepted: 03/03/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Jackson J Liang
- Department of Internal Medicine, Mayo Clinic Rochester, Minnesota
| | - Phil A Hart
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota
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Abdel Samie A, Theilmann L. Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy. Expert Rev Gastroenterol Hepatol 2012; 6:553-8; quiz 559. [PMID: 23061706 DOI: 10.1586/egh.12.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding. Diagnosis can be readily identified with sonography and confirmed with computed tomography. Early diagnosis is crucial as most patients can be treated successfully without surgery. Conservative treatment is recommended for intramural intestinal hematomas, when other associated complications needing laparotomy have been excluded.
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Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
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Efe C, Ozseker B, Kav T, Harmanci O, Bayraktar Y. Intramural hematoma of the esophagus as a complication of anticoagulant or antiplatelet therapy. Scand J Gastroenterol 2011; 46:1399-400. [PMID: 21644848 DOI: 10.3109/00365521.2011.591429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Anticoagulant-induced intramural hematoma of the jejunum. Clin J Gastroenterol 2011; 4:387-90. [DOI: 10.1007/s12328-011-0256-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 08/21/2011] [Indexed: 11/29/2022]
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Khan F, Vessal S. The disappearing abdominal mass: a duodenal pseudotumour. BMJ Case Rep 2011; 2011:bcr.01.2011.3746. [PMID: 22689546 DOI: 10.1136/bcr.01.2011.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Reports of inflammatory pseudotumours can be found in the literature affecting different organs of the body. The authors present a case and discuss the differential diagnosis of an inflammatory duodenal mass. Both symptomatology and radiological findings suggested a more sinister cause, such as a malignancy. However, histological analysis revealed normal mucosa and after conservative management the mass spontaneously resolved.
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Affiliation(s)
- Faraan Khan
- Department of General Medicine, Barnet Hospital, London, UK.
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