ABSTRACT 744

Abstract

Background and aims: Vomiting is a common non-specific symptom of disorders that can range from mild to severe conditions in children. Determining the serious conditions such as intracranial pressure elevation or intestinal obstruction is the most important consideration in management of vomiting. We report an unusual case of vomiting presenting as an insidious intestinal obstruction associated with intramural duodenal hematoma. Methods: Case: A seven-year-old patient presented with mild nausea and vomiting. On physical examination he had only mild dehydration. Laboratory results showed hypokalemic, hypochloremic severe metabolic alkalosis. Plain abdominal x-ray was normal. On follow-up he had a projectile vomiting just after minimal fluid intake. Abdominal ultrasound was performed and revealed a probable duodenal mass. Abdominal CT identified an intramural mass consistent with blood measuring 6 × 3.5 cm in the third portion of the duodenum and 8 × 6 cm in the proximal part of jejunum. On admission parents mentioned about no history of trauma. Based on the results, it is learned from the detailed questioning of parents, they remembered that he was left with the babysitter, fell down the stairs and bruised on his back two weeks ago, He was managed conservatively with bowel rest, continuous nasogastric decompression, total parenteral nutrition. Symptoms resolved over the course of the hospitalization without any need of surgical operation. Conclusions: This case highlights a rare cause of vomiting. Trauma usually present with acute symptoms. However, in cases of persistant vomiting, late symptomatic causes of trauma such as pancreatic pseudocyst, hemobilia and duodenal hematoma should be considered, even if without previous history of trauma.