Intramural duodenal hematoma after endoscopic biopsy in leukemic patients

Intramural Duodenal Hematoma after Endoscopic Therapy for a Bleeding Duodenal Ulcer in a Patient with Liver Cirrhosis

“…To our knowledge, 16 cases of nontraumatic intramural hematoma of the duodenum have been reported as a complication of endoscopic biopsy or sclerotherapy (8)(9)(10)(11)(12)(13)(14)(15). As shown in Table 2, six cases of duodenal hematomas are reported after endoscopic therapy for bleeding ulcers (13)(14)(15).…”

“…On the other hand, ten cases of nontraumatic duodenal hematoma were reported as a complication of endoscopic biopsy (8)(9)(10)(11)(12). Seven of those patients were under 15 years old and four patients had leukemia.…”

“…It is also, and less commonly, reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease and collagen vascular disease (1)(2)(3)(4)(5)(6). Intramural hematoma of the duodenum has been reported as a complication of diagnostic or therapeutic endoscopy (7)(8)(9)(10)(11)(12)(13)(14)(15). We report a case of intramural hematoma of the duodenum after clipping of a bleeding duodenal ulcer and endoscopic injection of epinephrine in a patient with liver cirrhosis, and review reports of iatrogenic intramural hematoma of the duodenum.…”

Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes

“…Papillitis with intra-and extrahepatic biliary strictures secondary to CMV has been reported in other immunocompromised patient populations but rarely in marrow transplant recipients. [17][18][19][20][21] In case 5, although CMV was never isolated from the biliary tree because of ganciclovir treatment, 22 the clinical and cholangiographic images were typical of CMV. In the past, CMV was a common opportunistic infection occurring in up to 60% of patients.…”

“…Bleeding after duodenal biopsy has been described in children and in marrow transplant patients. 17 It is our current policy to avoid biopsies of the duodenum when we suspect GVHD, but rather to biopsy gastric mucosa. 23 The relatively rich blood supply from the gastroduodenal artery and its arcuate branches, the coagulopathy of marrow transplant patients and the friability of the duodenal wall in acute GVHD all contribute to the increased risk of hemorrhage after biopsy.…”