title: Duodenal haematoma following endoscopy as a marker of coagulopathy.
abstract: BACKGROUND
  Intramural duodenal haematomas (IDHs) are a rare complication of endoscopic biopsy but can cause significant morbidity and mortality, including duodenal obstruction, hospitalization and needing intravenous feeding. They are extremely uncommon in those with normal haematology.
  
  
  OBJECTIVE
  To describe the occurrence of IDHs following endoscopic biopsy in our institution.
  
  
  METHODS
  We identified three patients who developed a post biopsy IDH during an 18-month period (2010-2012) in a retrospective search of our hospital pathology and imaging databases.
  
  
  RESULTS
  All three children had complex medical problems and presented with gastrointestinal symptoms including severe abdominal pain, reflux, poor feeding and abnormal gut transit time. All underwent normal upper GI endoscopy with duodenal biopsy. Following endoscopy, they presented with intermittent GI obstruction with severe abdominal pain, distension and bilious vomiting or symptoms of pancreatitis, had imaging features of IDH and were managed conservatively making a full recovery. Initial haematology including platelet counts were normal, but two children were subsequently found to have platelet dysfunction and the third to have an unclassified coagulopathy.
  
  
  CONCLUSIONS
  IDHs may be the presenting factor in children with unsuspected bleeding problems. We present these findings to raise awareness of the imaging features and clinical impact of these cases because better understanding of these risk factors may help to avoid these complications in children in the future.
authors.affiliation: Departments of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, University College of London, London, WC1N 3JH, UK.
authors.forename: Shema
authors.initials: S
authors.lastname: Hameed
authors.forename: Kieran
authors.initials: K
authors.lastname: McHugh
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
mesh_terms: D001706:Biopsy / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004378:Duodenal Diseases / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies