Surgical management of complicated intra-mural duodenal hematoma: A case-report and review of literature

Walid Elmoghazy; Islam Noaman; Ahmed-Emad Mahfouz; Ahmed Elaffandi; Hatem Khalaf

doi:10.1016/j.ijscr.2015.10.028

Surgical management of complicated intra-mural duodenal hematoma: A case-report and review of literature

Int J Surg Case Rep. 2015:17:103-5. doi: 10.1016/j.ijscr.2015.10.028. Epub 2015 Oct 30.

Authors

Walid Elmoghazy¹, Islam Noaman², Ahmed-Emad Mahfouz³, Ahmed Elaffandi⁴, Hatem Khalaf⁵

Affiliations

¹ Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: wshehata@hamad.qa.
² Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: INoaman@hamad.qa.
³ Department of Radiology, Hamad General Hospital, Doha, Qatar. Electronic address: AMAHFOUZ@hamad.qa.
⁴ Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: AElaffandi@hamad.qa.
⁵ Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: HKhalaf2@hamad.qa.

Abstract

Introduction: Intramural duodenal hematoma (IDH) is a rare pathological entity that occurs as a complication of trauma, pancreatitis, peptic ulcer disease or endoscopic biopsy procedures. In this report, we present a case of IDH related to a duodenal diverticulum that was complicated by intra-abdominal bleeding and peritonitis.

Presentation of case: We report a 31-year old male who presented with pancreatitis that was complicated with IDH, as diagnosed using endoscopy and CT scan of the abdomen. The condition was related to a duodenal diverticulum as appears on imaging. The patient was treated conservatively over a course of 1 week when he started to have intra-abdominal bleeding and developed peritonitis. The patient was successfully treated with laparotomy, drainage of intra-abdominal abscess, evacuation of IDH and repair of duodenal perforation. We discuss this case in the context of the current indications of surgery in cases of IDH.

Conclusion: Despite shift towards conservative management of IDH cases over last few decades, these cases should be handled carefully as they might develop life-threatening complications.

Keywords: Bleeding; Duodenal diverticulum; Duodenal hematoma; Failed conservation; Surgical management.