Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

Abstract

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

Spontaneous Intramural Duodenal Hematoma: Pancreatitis, Obstructive Jaundice, and Upper Intestinal Obstruction

“…Although there has been a case report of endoscopic decompression for intramural duodenal hematoma with gastric outlet obstruction to relieve the symptoms of the obstruction [15], this procedure requires further investigation.…”

Intramural duodenal hematoma secondary to pancreatitis: case report and review of the literature

“…However, it has limitations, given that it cannot be used for areas of bleeding that are inaccessible to the intestinal lumen. 8 Arterial embolization seems to be effective for management of bleeding. Embolization is considered successful when both radiologically and clinically there is evidence of bleeding control characterized by hemoglobin stabilization and absence of signs and symptoms of shock.…”

Conservative management of traumatic acute intramural hematoma of duodenal 2nd and 3rd portion: A case report and review of literature

“…15 Endoscopic drainage with mucosal puncture or fistula formation has also been performed without significant complications. 16 If accessible through the skin, percutaneous catheter insertion was also performed for decompression of IMDH. 17 However, several case reviews and retrospective studies revealed the effectiveness of conservative care in traumatic IMDH.…”