Sonographic diagnosis and monitoring of an intramural duodenal hematoma following upper endoscopic biopsy in a child

Zarifi, Maria; Gentimi, Fotini; Christopoulos-Geroulanos, George

doi:10.1002/jcu.20629

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…Some authors have suggested that a particular anatomy of the duodenum or of its vascularization could be the explanation for the higher incidence of this pathology in the young . Regardless of this hypothesis, as the number of endoscopic biopsies increases, it becomes clear that the number of cases of iatrogenic duodenal hematoma in healthy children may also increase …”

Section: Discussionmentioning

confidence: 99%

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Postendoscopic duodenal hematoma in children: Ultrasound diagnosis and follow‐up

Dumitriu

Menten

Smets

et al. 2014

J of Clinical Ultrasound

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Intramural duodenal hematomas have most frequently been reported in children in a traumatic setting. We present two cases of duodenal hematoma that occurred after upper gastrointestinal tract endoscopy with biopsy in children without significant prior medical history. The diagnosis was made by ultrasound, in correlation with the clinical presentation. Because the patients were hemodynamically stable, they were treated conservatively and the regression of the hematoma was followed up with ultrasound until its complete resolution. These cases demonstrate the risks of endoscopy, which are not to be neglected even in children without impaired coagulation, and the manner in which ultrasound can provide the correct diagnosis and follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Multislice imaging techniques such as CT or, preferably, MRI, may be useful in equivocal situations, as they both correctly identify fresh blood or blood products . However, proper taking of history and analysis of the sonographic findings make these techniques unnecessary in most cases …”

Section: Discussionmentioning

confidence: 99%

Postendoscopic duodenal hematoma in children: Ultrasound diagnosis and follow‐up

Dumitriu

Menten

Smets

et al. 2014

J of Clinical Ultrasound

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“…It is a rapid, noninvasive test, does not expose the patient to ionizing radiation and, in combination with plain film, can often exclude the diagnosis of perforation. 4 Additionally, ultrasound is an excellent adjunctive tool to be used in monitoring the size and subsequent resolution of a hematoma, as was done in the patient in our case study. The majority of patients with IDH are managed conservatively; surgical treatment is commonly reserved for those who have perforation.…”

Section: Discussionmentioning

confidence: 90%

“…[2][3][4][5][6] However, ultrasound has become an effective, initial screening tool used in the diagnosis of IDH and has several benefits. It is a rapid, noninvasive test, does not expose the patient to ionizing radiation and, in combination with plain film, can often exclude the diagnosis of perforation.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Hematemesis in a 12-Month-Old

Mueller

Schroeder

Kaila³

et al. 2015

Pediatric Emergency Care

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A 12-month-old male with a history of failure to thrive and hypothyroidism presented to a pediatric emergency department twice in a 24-hour period with complaint of hematemesis. The patient had a recent upper endoscopy and biopsy as part of a work-up for failure to thrive, but had no other pertinent positives in clinical history. Ultrasound demonstrated findings concerning for an intramural duodenal hematoma. The patient was admitted to the gastroenterology service for intravenous hydration and nasogastric decompression. He did not require any invasive management or blood products. Duodenal hematoma is a known, but very uncommon complication of upper endoscopy.

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“…Ultrasound provides immediate information about the presence and the age of the haematoma. It is also used serially to observe the resolution of the haematoma [34]. Upper gastrointestinal series describe well the duodenal obstruction and may also demonstrate perforation.…”

Section: Discussionmentioning

confidence: 99%

Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature

Grasshof¹,

Wolf²,

Neuwirth

et al. 2012

Case Rep Gastroenterol

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The development of intramural duodenal haematoma (IDH) after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia.

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Sonographic diagnosis and monitoring of an intramural duodenal hematoma following upper endoscopic biopsy in a child

Cited by 9 publications

References 19 publications

Postendoscopic duodenal hematoma in children: Ultrasound diagnosis and follow‐up

Postendoscopic duodenal hematoma in children: Ultrasound diagnosis and follow‐up

An Unusual Case of Hematemesis in a 12-Month-Old

Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature

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