Korean J Gastrointest Endosc.  2007 Jun;34(6):346-350.

A Case of Intramural Duodenal Hematoma Complicated with Obstructive Jaundice and Pancreatitis following Endoscopic Hemostasis

• Lee HC
• Kim KH
• Park YS
• Moon HJ
• Kim TN
• Jang BI

Abstract

An intramural duodenal hematoma is rarely observed in adults and may occur as an iatrogenic complication after endoscopic treatment for duodenal ulcer bleeding, particularly in patients with bleeding disorders or undergoing anticoagulant therapy. Upper gastrointestinal endoscopy, abdominal CT scan and hypotonic duodenography are used to establish a diagnosis. We report a case of an intramural duodenal hematoma complicated with obstructive jaundice and pancreatitis after endoscopic hemostasis in a patient with a cerebral infarction. A 64-year-old male had duodenal ulcer bleeding, which was treated by a local injection of epinephrine followed by hemoclipping. One to three days after the endoscopic treatment, he complained of abdominal pain and jaundice. The abdominal CT scan revealed acute, edematous pancreatitis and a huge hematoma in the 2nd to 4th portion of the duodenum. The follow-up endoscopy revealed severe stenosis of the duodenal lumen caused by an intramural hematoma. He was treated with conservative management for 18 days. There was gradual improvement in the hematoma that had been complicated by jaundice and pancreatitis.

Keyword

Intramural hematoma; Duodenum; Endoscopy

MeSH Terms

Abdominal Pain
Adult
Cerebral Infarction
Constriction, Pathologic
Diagnosis
Duodenal Ulcer
Duodenum
Endoscopy
Endoscopy, Gastrointestinal
Epinephrine
Follow-Up Studies
Hematoma*
Hemorrhage
Hemostasis, Endoscopic*
Humans
Jaundice
Jaundice, Obstructive*
Male
Middle Aged
Pancreatitis*
Tomography, X-Ray Computed
Epinephrine