Post-traumatic intramural duodenal hematoma in children.
BACKGROUND
Intramural duodenal hematoma generates partial or complete obstruction that develops slowly and progressively with a consequent delay in diagnosis. Many diagnostic and therapeutic measures remain debatable and justify a review of current management policy.


OBJECTIVE
To highlight the diagnostic and therapeutic steps in pediatric IDH.


METHODS
The records of 12 children with post-traumatic IDH who were treated in the Hillel Yaffe Medical Center between 1986 and 2000 were retrospectively reviewed. Three of them had clotting disorders and were excluded. The interval between their admission and diagnosis as well as the therapeutic decisions were evaluated and analyzed.


RESULTS
Nine children were treated for IDH. The interval between admission and diagnosis ranged from 24 hours to 6 days. Five children had associated traumatic pancreatitis. Initially, all the children were conservatively treated. In seven the hematoma resolved after 9-20 days. Two children were operated upon because the obstruction failed to resolve. All nine children recovered without permanent complications.


CONCLUSIONS
Intramural duodenal hematoma has many clinical and therapeutic puzzling aspects. Bicycle handlebar, road accidents and sports trauma are the main etiologic factors in children, but child abuse should be kept in mind. Associated traumatic pancreatitis is common. Gastroduodenal endoscopy may be useful to clarify doubtful cases. Pediatric surgeons should increase awareness regarding IDH in order to reduce delay in diagnosis and the need for surgical decompression.
Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
Miguel
M
Iuchtman
Tzvi
T
Steiner
Tzvi
T
Faierman
Alla
A
Breitgand
Gabriel
G
Bartal
D000007:Abdominal Injuries / Q000150:complications*; D000063:Accidents, Traffic; D000293:Adolescent; D001642:Bicycling / Q000293:injuries; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*