title: Intramural duodenal hematoma after endoscopic therapy for a bleeding duodenal ulcer in a patient with liver cirrhosis.
abstract: We report a case of intestinal obstruction due to intramural hematoma of the duodenum following therapeutic endoscopy for a bleeding duodenal ulcer in a patient with liver cirrhosis. A 44-year-old man was admitted to our hospital with severe epigastralgia, nausea and tarry stool. Two years previously he had undergone endoscopic sclerotherapy for esophageal varices caused by alcoholic liver cirrhosis. Endoscopy revealed an open ulcer with a bleeding vessel in the duodenal bulb, and sclerotherapy was performed by clipping the vessel and injecting 20 ml of 0.2% epinephrine. His platelet count was 3.5x10(4)/mul. Twelve hours later, he again developed epigastralgia and hypotension. Emergency computed tomography and ultrasonography revealed an intramural hematoma, 15x18 cm in diameter, at the dorsal and lateral duodenum. Endoscopy and upper gastrointestinal series revealed severe stenosis of the duodenal lumen caused by intramural hematoma. He received parenteral feeding for 22 days and within 8 weeks the hematoma was gradually absorbed using conservative management. Intramural duodenal hematoma may be diagnosed as a complication of the endoscopic procedure in a patient with a bleeding tendency, such as liver cirrhosis.
authors.affiliation: Department of Internal Medicine, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sugai
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajiwara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Eijiro
authors.initials: E
authors.lastname: Noma
authors.forename: Jo
authors.initials: J
authors.lastname: Nakashima
authors.forename: Koutaro
authors.initials: K
authors.lastname: Uchimura
authors.forename: Seizou
authors.initials: S
authors.lastname: Sadoshima
mesh_terms: D000328:Adult; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D004381:Duodenal Ulcer / Q000150:complications* / Q000628:therapy*; D004384:Duodenoscopy / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D011859:Radiography; D015911:Sclerotherapy / Q000009:adverse effects