Bowel obstruction caused by an intramural duodenal hematoma: a case report of endoscopic incision and drainage.
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10 x 5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Kwon
Chang-Il
CI
Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea.
Ko
Kwang Hyun
KH
Kim
Hyo Young
HY
Hong
Sung Pyo
SP
Hwang
Seong Gyu
SG
Park
Pil Won
PW
Rim
Kyu Sung
KS
D004322:Drainage; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006406:Hematoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D014057:Tomography, X-Ray Computed