Intramural Hematoma of the Duodenum in a Patient with Chronic Pancreatitis

Abstract

Intramural hematoma of the duodenum is usually caused by blunt abdominal injury. Sometimes this lesion occurs in patients with coagulation disturbances or pancreatic disease such as chronic pancreatitis. There also appears to be a link with alcohol abuse. We describe the case-history of a 45-year-old male with chronic pancreatitis who presented with abdominal pain. The diagnosis of a space-occupying process of the duodenum was made and subsequently a pancreatico-duodenectomy was performed. The duodenum revealed an intramural hematoma, the pancreas showed signs of mild chronic pancreatitis.

Imaging Diagnosis-Spontaneous Intramural Canine Duodenal Hematoma

“…In humans, intramural duodenal hematoma secondary to trauma is usually subserosal and spontaneous intramural duodenal hematomas are usually submucosal 9 . An intramural duodenal hematoma within the tunica muscularis occurred in a human with chronic pancreatitis 10 . In the horse, intestinal hematomas most often involve the jejunum and small colon 1,3−5 .…”

“…Spontaneous intramural intestinal hematomas also occur in humans due to a coagulopathy 25−28 . Other less common causes include endoscopic small bowel biopsy, 29 intestinal ulceration, 12 and pancreatic disease 10,30,31 . Intramural duodenal hematomas have been described in association with different types of pancreatic disease, such as acute and chronic pancreatitis, 10,11 pancreatic neoplasia, 31 and ectopic pancreatic tissue inside the duodenal wall 32 .…”

Duodenal hematoma secondary to acute chronic pancreatitis: case report and literature review

“…The second hypothesis states that the increase of pancreatic enzymes causes lesion of vessels of the anteroposterior pancreato duodenal arcade. 6 In a literature review performed by Oliveira et al, 7 males were the most affected (85.7%), ranging in age from 27years to 71years (mean 53years). The alcoholic etiology of pancreatitis was the most common cause.…”

Intramural Duodenal Hematoma and Hemoperitoneum in Anticoagulant Therapy following Upper Gastrointestinal Endoscopy

“…Duodenal intramural hematoma should be considered in any patient with abdominal pain, nausea and vomiting who is receiving long-term anticoagulation therapy, particularly following diagnostic or therapeutic UGI endoscopy. Additionally, some patients can develop acute pancreatitis or biliary obstruction [3,11] . Routine laboratory tests in such cases should include PT, PPT, and INR.…”

“…It is usually caused by blunt abdominal trauma [1] , and occurs mainly in young men and children, with 82% of the patients being younger than 30 years [2] . Sometimes this lesion occurs in patients with pancreatic disease [3] , coagulopathy [4] , postendoscopic biopsy [5] , or anticoagulant therapy [6] . Nevertheless, intramural duodenal hematoma and hemoperitoneum as complications following nontherapeutic upper gastrointestinal (UGI) endoscopy without biopsies in a patient on anticoagulant therapy has not been reported previously.…”