Iatrogenic Duodenal Intramural Hematoma Presenting as Acute Pancreatitis

Abstract

Duodenal intramural hematomas are very uncommon. They are usually caused by blunt abdominal trauma and can also occur in patients who receive anticoagulant therapy or who present with blood dyscrasias or pancreatic disease. Among such cases, iatrogenic duodenal intramural hematomas are considered extremely rare. The authors report a case of iatrogenic duodenal intramural hematoma presenting as acute pancreatitis. The patient was a 28-year-old male admitted due to severe nausea and vomiting which developed after receiving therapeutic endoscopy for bleeding acute duodenal ulcer. Elevated serum amylase, lipase and total bilirubin were noted and acute pancreatitis was the initial diagnosis. On abdominal computed tomography (CT) a mass lesion was found compressing the duodenal lumen. Panendoscopy was performed and a submucosal hematoma protruding from the distal part to the junction of the bulb and first portion of duodenum was found. The patient underwent surgery and the hematoma was completely evacuated. He gradually recovered after the operation. The possibility of iatrogenic duodenal intramural hematoma should be considered in any patient presenting with severe nausea/vomiting or epigastric pain after diagnostic or therapeutic endoscopy, especially if there is jaundice or elevated serum amylase/lipase.