title: Surgical management of complicated intra-mural duodenal hematoma: A case-report and review of literature.
abstract: BACKGROUND
  Intramural duodenal hematoma (IDH) is a rare pathological entity that occurs as a complication of trauma, pancreatitis, peptic ulcer disease or endoscopic biopsy procedures. In this report, we present a case of IDH related to a duodenal diverticulum that was complicated by intra-abdominal bleeding and peritonitis.
  
  
  METHODS
  We report a 31-year old male who presented with pancreatitis that was complicated with IDH, as diagnosed using endoscopy and CT scan of the abdomen. The condition was related to a duodenal diverticulum as appears on imaging. The patient was treated conservatively over a course of 1 week when he started to have intra-abdominal bleeding and developed peritonitis. The patient was successfully treated with laparotomy, drainage of intra-abdominal abscess, evacuation of IDH and repair of duodenal perforation. We discuss this case in the context of the current indications of surgery in cases of IDH.
  
  
  CONCLUSIONS
  Despite shift towards conservative management of IDH cases over last few decades, these cases should be handled carefully as they might develop life-threatening complications.
authors.affiliation: Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: wshehata@hamad.qa.
authors.forename: Walid
authors.initials: W
authors.lastname: Elmoghazy
authors.affiliation: Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: INoaman@hamad.qa.
authors.forename: Islam
authors.initials: I
authors.lastname: Noaman
authors.affiliation: Department of Radiology, Hamad General Hospital, Doha, Qatar. Electronic address: AMAHFOUZ@hamad.qa.
authors.forename: Ahmed-Emad
authors.initials: AE
authors.lastname: Mahfouz
authors.affiliation: Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: AElaffandi@hamad.qa.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elaffandi
authors.affiliation: Department of Surgery, Division of Organ Transplant, Hamad General Hospital, Doha, Qatar. Electronic address: HKhalaf2@hamad.qa.
authors.forename: Hatem
authors.initials: H
authors.lastname: Khalaf
keywords: Bleeding; Duodenal diverticulum; Duodenal hematoma; Failed conservation; Surgical management