Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review

Abstract

Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonography and endoscopy, and it was complicated by acute pancreatitis. The lesions resolved with conservative management. We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis. In our patient, acute pancreatitis occurred concurrently with hematoma, probably due to obstruction of the duodenal papilla, or compression of the pancreas caused by the hematoma. The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.

Acute duodenal intramural hematoma complicated by acute pancreatitis—a rare complication of endoscopic epinephrine injection therapy

“…Very few (<30) cases of IDH after biopsy or sclerotherapy have been reported in the literature to our knowledge [ 9 ]. Most of these patients with IDH after hemostatic therapy had underlying coagulopathy, thrombocytopenia and/or liver cirrhosis [ 4 , 7 , 9 – 12 ]. Dibra et al [ 13 ] however reported a case of IDH after submucosal epinephrine therapy for duodenal bleeding ulcer in a patient without apparent underlying disease.…”

“…Our patient has a similar associated acute pancreatitis but without any known underlying coagulopathy or cirrhosis. The development of acute pancreatitis in cases of IDH has been attributed to hematoma compression of the pancreatic duct and obstruction of duodenal papilla [ 12 , 14 ]. Other explanations have included the possibility of pancreatic enzyme release during acute or chronic pancreatitis, causing vascular destruction thereby leading hematoma formation [ 7 ].…”

Acute Pancreatitis with an Intramural Duodenal Hematoma

“…Causes of the development of acute pancreatitis in patients with IDH include duodenal papilla obstruction and pancreatic duct compression (13). Obstructive acute pancreatitis is another complication resulting from impaired pancreatic enzyme secretion due to obstruction of the duodenal papilla.…”

Surgical management of complicated intra-mural duodenal hematoma: A case-report and review of literature

“…Similar shift can be observed in IDH cases, as shown in Table 1 , large case series and reports of IDH discussed 236 cases before the year 2000 and 157 (67%) cases were managed by operative intervention. After 2000, there are 46 reported cases of IDH with 10 (22%) of them required drainage [2] , [11] , [12] , [13] , [14] , [15] .…”