A Case of Intramural Duodenal Hematoma Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding

Min Keun Song; Joon Beom Shin; Ha Na Park; Eun Jin Kim; Ki Cheun Jeong; Dong Hwan Kim; Jae Bock Chung; Do Young Kim

doi:10.4166/kjg.2009.53.5.311

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Song, Shin, Park, Kim, Jeong, Kim, Chung, and Kim: A Case of Intramural Duodenal Hematoma Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding

Original Article

Korean J Gastroenterol 2009;53(5):311-314.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.53.5.311

A Case of Intramural Duodenal Hematoma Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding

Min Keun Song, M.D., Joon Beom Shin, M.D.^∗, Ha Na Park, M.D.^∗, Eun Jin Kim, M.D.^∗, Ki Cheun Jeong, M.D., Dong Hwan Kim, M.D., Jae Bock Chung, M.D.^∗, Do Young Kim, M.D.^∗,

Department of Internal Medicine, National Health Insurance Ilsan Hospital, Goyang, Korea

^∗Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Do Young Kim, M.D. Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun- gu, Seoul 120-752, Korea Tel: +82-2-2228-1992, Fax: +82-2-393-6884 E-mail: dyk1025@yuhs.ac

Received 17 November 2008 Accepted 27 February 2009

Abstract

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.

Keywords: Intramural duodenal hematoma, Therapeutic endoscopy, Acute pancreatitis

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Fig. 1.

Endoscopic findings. (A) Adherent blood clot was observed in the duodenal bulb. (B) After removal of blood clot, a stigmata of recent bleeding was exposed on the base of ulcer.

Fig. 2.

Abdominal CT scan findings. (A) A hematoma which was developed in the wall of duodenal 2nd and 3rd portion extended to the abdominal cavity. Common bile duct was dilated. (B) Pancreatic swelling with per-ipancreatic fat infiltration was noted.

Fig. 3.

Follow-up abdominal CT finding. The size of intraperitoneal hematoma was markedly decreased.

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