Traumatic Jejunal hematoma in childhood—A case report and review of literature

Abstract

HighlightsIntramural jejunal hematoma is very rare with only few cases reported in the literature.The trauma in majority of cases is trivial and usually the patients present late.It can present with intestinal obstruction.It should be suspected when a child presents with intestinal obstruction and history of blunt abdominal trauma.

Warfarin Poisoning and Blunt Abdominal Trauma: A Rare Cause of Small Bowel Obstruction

“…This is thought to be due to its fixed position over the vertebral column and disruption of mesenteric attachments [ 2 , 3 , 16 - 17 ]. Jejunal mural hematomas have been reported, however, they are more commonly associated with coagulopathies or systemic disorders [ 6 , 9 - 10 ]. There is higher reported incidence of jejunal injuries in pediatric populations after abdominal wall trauma likely due to the decreased abdominal musculature [ 3 , 6 ].…”

“…Jejunal mural hematomas have been reported, however, they are more commonly associated with coagulopathies or systemic disorders [ 6 , 9 - 10 ]. There is higher reported incidence of jejunal injuries in pediatric populations after abdominal wall trauma likely due to the decreased abdominal musculature [ 3 , 6 ]. On CT imaging, traumatic hematomas are usually characterized by short focal segment of the affected bowel compared to more extensive involvement seen in coagulopathic bleeding [ 10 ].…”

“…Spontaneous small intestine intramural hematoma is a rare complication of anticoagulant use, reported to occur in about one case per 2500 patients on anticoagulant therapy per year [ 4 ]. Conversely, intramural hematomas secondary to blunt abdominal trauma are a more common, yet still rare, phenomenon [ 5 , 6 ]. We present the case of an anticoagulated patient with a small bowel obstruction secondary to an intramural hematoma from blunt abdominal trauma, requiring emergent bowel resection.…”

Intramural duodenal haematoma with mucosal prolapse causing intestinal obstruction

“…There is a gradual progression of symptoms with the onset of severe pain and vomiting indicating the development of obstruction. The delay between the injury and onset of obstructive symptoms is explained by the gradual increase in the haematoma due to the progression of bleeding and absorption of fluids secondary to the increased osmolarity 12 13. Symptoms of gastrointestinal bleeding and jaundice are also rarely seen.…”

“…In the case of large haematomas and complete obstruction, surgery is the mainstay of treatment. Simple evacuation of the haematoma has been proven to be inadequate, and resection with primary anastomosis or additional bypass procedures are usually indicated 13. There are also reports of successful image-guided drainage (USG or CT) in select cases, but long-term follow-up is not available 9.…”