Intraduodenal hematoma complicating intestinal biopsy: Case reports and review of the literature

Abstract

We report two cases of postbiopsy duodenal hematoma and review 14 additional cases. Duodenal hematoma predominantly occurs in children and presents with abdominal pain, vomiting, and pancreatitis. Upper gastrointestinal series, abdominal ultrasound, and CT scan are useful in visualizing the hematoma. No comparative studies of the usefulness of these techniques are available, but a CT is indicated if perforation is suspected. The treatment is conservative if no perforation is detected, and resolution of symptoms generally occurs within 2 wk.

Intramural haematoma of the duodenum following endoscopic biopsy: an unusual complication of non-therapeutic endoscopy in children

“…Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric suction and parenteral nutrition is suggested until resolution of the haematoma. In the majority of cases, a complete resolution is observed within 2 to 3 weeks [1], as illustrated by our case. Prognosis is usually good and without sequelae except in sporadic cases of chronic pancreatitis [3].…”

“…The development of an intramural duodenal haematoma after endoscopic small bowel biopsy has been reported in nine children, some of them being leukaemic patients or bone marrow transplant recipients [1] and in seven children when using capsule biopsy. It is difficult to state the frequency of intramural duodenal haematoma after biopsy; complications of this procedure develop in less than 2% of cases and are usually mild [4].…”

Intramural duodenal hematoma after upper gastrointestinal endoscopy

“…Nasogastric suction, fluid and electrolyte replacement, and parenteral nutrition may be the treatment of choice in uncomplicated cases [1,2,7,11,15]. Surgical intervention may be reserved for cases with the occurrence of perforation, fistula formation and bile or pancreatic duct compression [11,14,15]. Surgical treatment has also been suggested to be considered if there is no resolution of the obstruction within 7 to 10 days [13,14], albeit the case presented herein may actually argue against such a strategy.…”

“…Surveillance for the development of complications from pancreatic or biliary duct obstruction secondary to the duodenal hematoma, as well as prevention of secondary infection of the hematoma appear to be pre-eminent goals of conservative management. Nasogastric suction, fluid and electrolyte replacement, and parenteral nutrition may be the treatment of choice in uncomplicated cases [1,2,7,11,15]. Surgical intervention may be reserved for cases with the occurrence of perforation, fistula formation and bile or pancreatic duct compression [11,14,15].…”

“…Radiological studies as performed here are useful to identify more common potential complications of upper GI endoscopy, and a CT scan may be useful to reveal the actual cause of symptoms. This imaging modality may reveal the hematoma and exclude perforation and biliary obstruction, and may also allow assessment of the pancreas [2,11,12]. Ultrasound is useful during follow-up because it is rapid, noninvasive and economical [1,13].…”