Abstract
Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later. Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.
Highlights
The first description of an intramural duodenal hematoma was made by McLauchlan in 1838
This study sought to describe a case of an intramural duodenal hematoma caused by chronic exacerbation of pancreatitis
Duodenal hematomas have been described as complications of both acute and chronic pancreatitis
Summary
The first description of an intramural duodenal hematoma was made by McLauchlan in 1838. This study sought to describe a case of an intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. A computed tomography (CT) scan showed signs of chronic pancreatitis and a bulky submucosal duodenal hematoma from the bulb to the third portion of the duodenum with intramural active bleeding in the region of the gastroduodenal artery (Figure 1A). Duodenal rupture from the bulb to the second portion of the duodenum, along with signs of acute pancreatitis.
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