Intramural duodenal hematoma and hemoperitoneum after endoscopic treatment in a patient with chronic renal failure on hemodialysis: a case report

Sungjin Chung,Seok Joon Shin,Hyun Wha Chung,Yoon Sik Chang,Cheol Whee Park

doi:10.1186/1757-1626-2-9083

Abstract

IntroductionAn intramural duodenal hematoma is a rare but recognized complication that usually develops after abdominal trauma, predominantly in children and young adults.Case PresentationWe report the case of a patient that developed an intramural duodenal hematoma after endoscopic treatment for a bleeding ulcer who also was undergoing conventional hemodialysis for chronic renal failure associated with lupus nephritis. A hemoperitoneum and near-total duodenal obstruction developed but spontaneously resolved with conservative treatment.ConclusionClinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

Highlights

An intramural duodenal hematoma is a rare but recognized complication that usually develops after abdominal trauma, predominantly in children and young adults.Case Presentation: we report the case of a patient that developed an intramural duodenal hematoma after endoscopic treatment for a bleeding ulcer who was undergoing conventional hemodialysis for chronic renal failure associated with lupus nephritis
The risks are usually considered minimal, there are reports that intramural duodenal hematomas can develop as a complication after diagnostic or therapeutic endoscopy, especially in patients susceptible to hemorrhage such as those with end-stage renal disease (ESRD) [1,2]
We report here the case of a patient that developed an intramural hematoma of the duodenum after endoscopic treatment for a bleeding ulcer using epinephrine injection and hemoclipping; the patient had end-stage renal failure due to lupus nephritis and was undergoing hemodialysis

Summary

Introduction

Endoscopic hemostatic procedures such as local injection of epinephrine, polidocanal and fibrin tissue adhesive onto the mucosa, and hemoclipping are commonly used for the treatment of bleeding ulcers, instead of the open surgical approaches used in the past [1]. We report here the case of a patient that developed an intramural hematoma of the duodenum after endoscopic treatment for a bleeding ulcer using epinephrine injection and hemoclipping; the patient had end-stage renal failure due to lupus nephritis and was undergoing hemodialysis. An injection of 0.2% epinephrine to a total of 2.5 mL with subsequent hemoclipping was performed for the duodenal ulcers with active bleeding (Figure 1). A diagnosis of duodenal obstruction, due to an intramural duodenal hematoma with hemoperitoneum, was made on the basis of the CT and follow-up endoscopic appearance and the progression of the anemia. After 10 days, an upper gastrointestinal series using gastrograffin revealed a partial obstruction at the level of the second portion of the duodenum without definite evidence of leakage (Figure 4). IdFnuiigtoiuadlreennu1dmostchoatpiwc efirnedihnegms orecvliepapled bleeding ulcers of the Initial endoscopic findings revealed bleeding ulcers of the duodenum that were hemoclipped

Findings

Discussion

Conclusion