Large Duodenal Hematoma Causing an Ileus after an Endoscopic Duodenal Biopsy in a 6-Year-Old Child: A Case Report

Schiller, Benjamin; Radkë, Michaël; Hauenstein, Christina; Müller, Carsten H. G.; Spang, Christian; Reuter, Daniel A.; Däbritz, Jan; Ehler, Johannes

doi:10.3390/medicina58010012

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Despite the slight changes in INR in newly diagnosed CD individuals, reflecting a tendency toward increased bleeding risk, there are no data showing an increased rate of hemorrhagic complications from endoscopic biopsies required for diagnosis, except for isolated case reports [55,62]. Moreover, there are already validated criteria for non-bioptic diagnosis in pediatric CD [63], and several studies have evaluated the feasibility of a biopsy-avoiding diagnostic strategy in adults as well [64,65], which would eliminate all potential complications associated with endoscopy and duodenal mucosal sampling.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Balaban,

Coman,

Enache

et al. 2023

Gastroenterology Insights

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Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Balaban,

Coman,

Enache

et al. 2023

Gastroenterology Insights

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“…1 Intramural duodenal hematoma can lead to potentially fatal complications; therefore, prompt diagnosis is crucial for successful treatment. 2 Point-of-care sonography is a feasible and convenient modality for diagnosis. Sonographic findings included a round or tubular echogenic mass above the spinal body near the subxiphoid area.…”

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confidence: 99%

Sonographic diagnosis of intramural duodenal hematoma

Wang

Cheng

Hou

2023

Pediatrics & Neonatology

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Challenges in the Diagnostics and Treatment of Duodenum Injuries in Children

GUMEROV¹,

KOMISSAROV²,

GUMEROV³

et al. 2022

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Objective: To study the clinical presentations and diagnosis of injuries to the duodenum in children. Methods: The study analyses the diagnosis and treatment of duodenal injuries in 14 children admitted to pediatric surgery departments at the Bashkir State Medical University, Ufa, Russia and Saint-Petersburg State Pediatric Medical University, Russia, between 2000 and 2020. The clinical presentations of duodenal injuries, diagnostic challenges and preoperative and intraoperative errors were evaluated. Results: High diagnostic error rates were observed since practitioners have a knowledge gap regarding the clinical presentation and surgical treatment principles of duodenal trauma among affected children. The authors believe that the presence of one of the symptoms (retroperitoneal hematoma, emphysema, yellowish green staining of the retroperitoneum and tissues is an indication for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Conclusion: Damage to the duodenum in children presents considerable difficulties in diagnosis and treatment. In this regard, imaging studies should be employed for diagnosis. Diagnostic laparoscopy is considered the gold standard for preoperative clinical evaluation. Retroperitoneal hematoma and/or emphysema, and yellow-green staining of the retroperitoneum and tissues, are indications for inspection of the retroperitoneal part of the duodenum, performed according to Kocher manoeuvre. Keywords: Duodenum, trauma, diagnosis, surgical treatment.

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Large Duodenal Hematoma Causing an Ileus after an Endoscopic Duodenal Biopsy in a 6-Year-Old Child: A Case Report

Cited by 3 publications

References 36 publications

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Sonographic diagnosis of intramural duodenal hematoma

Challenges in the Diagnostics and Treatment of Duodenum Injuries in Children

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