title: [Acute abdomen due to complicated intramural duodenal haematoma. Report of a case and review of the literature].
abstract: BACKGROUND
  Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours.
  
  
  METHODS
  The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y.
  
  
  CONCLUSIONS
  Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise.
  
  
  CONCLUSIONS
  Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, España. Electronic address: barea1984@gmail.com.
authors.forename: Rocío
authors.initials: R
authors.lastname: Molina-Barea
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pérez-Cabrera
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, España.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Hernández-García
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Navarro-Freire
authors.affiliation: Unidad de Gestión Clínica de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, España.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Jiménez-Ríos
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D004378:Duodenal Diseases / Q000150:complications*; D006406:Hematoma / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Abdominal pain; Cephalic duodenopancreatectomy; Chronic pancreatitis; Dolor abdominal; Duodenopancreactectomía cefálica; Hematoma intramural duodenal; Intramural duodenal hematoma; Pancreatitis crónica