title: Esophagogastroduodenal pneumatosis with subsequent pneumoporta and intramural duodenal hematoma after endoscopic hemostasis: a case report.
abstract: BACKGROUND
  Esophagogastroduodenal pneumatosis is the presence of air in esophagus, stomach, and duodenum simultaneously, which have never been described in the literature. Intramural duodenal hematoma (IDH) rarely occurs after endoscopic intervention. The diagnosis and treatment in both conditions are great challenge in daily practice.
  
  
  METHODS
  A 70-year-old male patient, who had been taking warfarin for artificial valve replacement, developed IDH and esophagogastroduodenal pneumatosis after endoscopic hemostasis for duodenal ulcer bleeding. Initially, he had abdominal pain, gastrointestinal bleeding and hypotension. Later, he was found to have acute pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin also ensued. The intramural duodenal hematoma and critical condition resolved spontaneously after conservative medical treatment.
  
  
  CONCLUSIONS
  Based on this case report, we suggest that intramural duodenal hematoma should be considered if a patient has the tetrad of pancreatitis, biliary obstruction, gastric outlet obstruction and rapid decline of hemoglobin after an endoscopic intervention. Those patients could be treated conservatively. But, surgery should be considered if the diseases progress or complications persist.
authors.affiliation: Divisions of Gastroenterology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing Long Road, Taipei, 116, Taiwan. egghouses@gmail.com.
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Divisions of Pulmonology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. chlee.tw@gmail.com.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. chlee.tw@gmail.com.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Divisions of Gastroenterology, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Hsing Long Road, Taipei, 116, Taiwan. fmsuk@tmu.edu.tw.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. fmsuk@tmu.edu.tw.
authors.forename: Fat-Moon
authors.initials: FM
authors.lastname: Suk
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D004378:Duodenal Diseases / Q000209:etiology*; D004646:Emphysema / Q000209:etiology*; D004935:Esophageal Diseases / Q000209:etiology*; D017219:Gastric Outlet Obstruction / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006406:Hematoma / Q000209:etiology*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications; D008297:Male; D010195:Pancreatitis / Q000150:complications; D013272:Stomach Diseases / Q000209:etiology*