Duodenal hematoma: Difference between revisions
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==Background== | ==Background== | ||
*Relatively uncommon, occurs most frequently in children after blunt abdominal trauma<ref>Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283</ref><ref>Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.</ref> | *Relatively uncommon, occurs most frequently in children after blunt [[abdominal trauma]]<ref>Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283</ref><ref>Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.</ref> | ||
**May also occur as a complication of endoscopy | **May also occur as a complication of endoscopy | ||
*Diagnosis difficult as symptoms often delayed<ref>Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283</ref><ref>Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.</ref> | *Diagnosis difficult as symptoms often delayed<ref>Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283</ref><ref>Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.</ref> | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:PMC4508937 crj-02-198-g002.png|thumb|EGD showing extrinsic compression by a bluish swelling (extra-parietal hematoma) in the first part of the duodenum, blocking passage in the second duodenal portion.]] | |||
*Delayed onset of: | *Delayed onset of: | ||
**[[Abdominal pain]] | **[[Abdominal pain]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Abdominal trauma DDX}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:PMC4435325 crj-01-209-g001.png|thumb|CT showing an 11 x 5 cm intramural duodenal hematoma secondary to pancreatitis (not seen).]] | |||
[[File:PMC4677192 CRIGM2015-201675.007.png|thumb|Abdominal CT showing an 8 cm × 6 cm × 11cm hematoma on the lateral duodenal wall, compressing and displacing the duodenum without signs of active extravasation.]] | |||
===Workup=== | ===Workup=== | ||
Labs: | Labs: | ||
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==Management== | ==Management== | ||
Hemodynamically stable | ===Hemodynamically stable=== | ||
*Conservative management with NG tube placement, enteral rest, [[IVF]], and pain control | *Conservative management with NG tube placement, enteral rest, [[IVF]], and pain control | ||
Hemodynamically unstable: | ===Hemodynamically unstable: === | ||
*OR for abdominal exploration | *OR for abdominal exploration | ||
==Disposition== | |||
*Admit | |||
==Complications== | ==Complications== | ||
Acute | ===Acute=== | ||
*Rarely caused in isolation. Other commonly involved sites include liver, pancreas, stomach/intestinal, and vascular injuries | *Rarely caused in isolation. Other commonly involved sites include liver, pancreas, stomach/intestinal, and vascular injuries | ||
*Gastric outlet or intestinal obstruction | *Gastric outlet or intestinal obstruction | ||
===Subacute=== | |||
*Intra-abdominal [[abscess]] | *Intra-abdominal [[abscess]] | ||
*Duodenal fistula | *Duodenal fistula | ||
*Post-traumatic [[pancreatitis]] | *Post-traumatic [[pancreatitis]] | ||
==See Also== | ==See Also== | ||
*[[Abdominal trauma]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 22:49, 4 January 2023
Background
- Relatively uncommon, occurs most frequently in children after blunt abdominal trauma[1][2]
- May also occur as a complication of endoscopy
- Diagnosis difficult as symptoms often delayed[3][4]
- Estimated mortality associated with duodenal injury ranges from 5 to 30% [5]
Clinical Features
- Delayed onset of:
- Abdominal pain
- Distension
- Nausea and vomiting
- Hematemesis
- Diminished bowel sounds
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
Workup
Labs:
- Serum lipase/amylase may be associated with duodenal injury, but both are not sensitive/specific.
Diagnosis
- If hemodynamically stable: CT abdomen with IV contrast
- If hemodynamically unstable: OR
Management
Hemodynamically stable
- Conservative management with NG tube placement, enteral rest, IVF, and pain control
Hemodynamically unstable:
- OR for abdominal exploration
Disposition
- Admit
Complications
Acute
- Rarely caused in isolation. Other commonly involved sites include liver, pancreas, stomach/intestinal, and vascular injuries
- Gastric outlet or intestinal obstruction
Subacute
- Intra-abdominal abscess
- Duodenal fistula
- Post-traumatic pancreatitis
See Also
External Links
References
- ↑ Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283
- ↑ Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.
- ↑ Shiozawa K, Watanabe M, Igarashi Y, Matsukiyo Y, Matsui T, Sumino Y. Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review. World J Radiol. 2010;2(7):283-288. doi:10.4329/wjr.v2.i7.283
- ↑ Deambrosis K, Subramanya MS, Memon B, Memon MA. Delayed duodenal hematoma and pancreatitis from a seatbelt injury. West J Emerg Med. 2011;12(1):128-130.
- ↑ García Santos E, Soto Sánchez A, Verde JM, Marini CP, Asensio JA, Petrone P. Duodenal injuries due to trauma: Review of the literature. Cir Esp. 2015 Feb;93(2):68-74. English, Spanish. doi: 10.1016/j.ciresp.2014.08.004. Epub 2014 Oct 27. PMID: 25443151.