title: Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review.
abstract: We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.
authors.forename: A
authors.initials: A
authors.lastname: Dibra
authors.forename: S
authors.initials: S
authors.lastname: Këlliçi
authors.forename: E
authors.initials: E
authors.lastname: Çeliku
authors.forename: Xh
authors.initials: X
authors.lastname: Draçini
authors.forename: A
authors.initials: A
authors.lastname: Maturo
authors.forename: E
authors.initials: E
authors.lastname: Çeliku
mesh_terms: D000293:Adolescent; D004381:Duodenal Ulcer / Q000628:therapy*; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology*; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology; D010288:Parenteral Nutrition; D013396:Suction; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
references.citation: Ann Surg. 1971 Apr;173(4):534-44
references.pmid: 5573645
references.citation: Lancet. 1991 Feb 23;337(8739):504
references.pmid: 1671516
references.citation: Surg Endosc. 1991;5(1):28-30
references.pmid: 1871671
references.citation: JPEN J Parenter Enteral Nutr. 2011 Sep;35(5):563-70
references.pmid: 21832143
references.citation: Ann Intern Med. 2010 Jan 19;152(2):101-13
references.pmid: 20083829
references.citation: Intern Med. 2005 Sep;44(9):954-7
references.pmid: 16258210
references.citation: Am J Gastroenterol. 1994 Nov;89(11):1968-72
references.pmid: 7942719
references.citation: Am J Surg. 1976 Dec;132(6):779-83
references.pmid: 998868
references.citation: Gut. 1991 Jul;32(7):727-9
references.pmid: 1855676
references.citation: Ann Gastroenterol. 2011;24(2):101-107
references.pmid: 24713707
references.citation: Digestion. 1983;26(4):231-5
references.pmid: 6873509
references.citation: Hepatogastroenterology. 1997 Jan-Feb;44(13):139-42
references.pmid: 9058132
references.citation: J Pediatr Surg. 1987 Nov;22(11):1009-10
references.pmid: 3323453
references.citation: Am J Surg. 1983 Mar;145(3):330-4
references.pmid: 6837855