Intramural duodenal haematoma with mucosal prolapse causing intestinal obstruction

Abstract

Intramural small bowel haematoma is a rare cause of intestinal obstruction in children. Coagulation disorders or anticoagulant therapy are the most common cause followed by blunt trauma. A one and half-year-old boy, with known case of gastro-oesophageal reflux disease had undergone upper gastrointestinal endoscopy and biopsy. Four days later, he presented to us with clinical features of small bowel obstruction. CT of the abdomen showed features suggestive of haemorrhagic duplication cyst. Explorative laparotomy revealed 15–20 cm of bowel from the third part of the duodenum to proximal jejunum filled with clotted blood and thinned out serosa. There was no evidence of intraluminal blood in the distal bowel loops. Resection of the involved bowel with primary anastomoses was done. Histopathological examination of bowel revealed intramural haematoma associated with prolapse of the mucosa. There was no evidence of duplication cyst or vascular malformations. Postoperative period was uneventful.

Obstrucción intestinal por hematoma intraabdominal: una complicación de la heparina de bajo peso molecular en el paciente pediátrico

“…Sin embargo, como el resto de anticoagulantes, presenta un riesgo de sangrado estimado en 0,6% y 1,8-8% a dosis profilácticas y terapéuticas respectivamente (5,6) . Como resultado, se ha observado un aumento de la incidencia de hematomas intestinales en pediatría, tanto por el efecto anticoagulante, que ha aumentado la tasa de hematomas espontáneos, como por el riesgo de punción directa de un asa intestinal durante la administración subcutánea, produciendo un hematoma traumático (5,7) .…”

Intestinal obstruction as a result of intra-abdominal hematoma: a complication of low molecular weight heparin in pediatric patients

“…However, like other anticoagulants, it has an estimated bleeding risk of 0.6% and 1.8-8% at prophylactic and therapeutic doses, respectively (5,6) . The incidence of intestinal hematomas in pediatrics has grown due to LMWH's anticoagulant effect -which has increased spontaneous hematomas-and to the risk of direct puncture on small bowel loops during subcutaneous administration -which causes traumatic hematomas (5,7) .…”