Bowel Obstruction Caused by an Intramural Duodenal Hematoma: A Case Report of Endoscopic Incision and Drainage.
10.3346/jkms.2009.24.1.179
- Author:
Chang Il KWON
1
;
Kwang Hyun KO
;
Hyo Young KIM
;
Sung Pyo HONG
;
Seong Gyu HWANG
;
Pil Won PARK
;
Kyu Sung RIM
Author Information
1. Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea. mdkwon71@freechal.com
- Publication Type:Case Report
- Keywords:
Hematoma, Intramural;
Duodenum;
Drainage
- MeSH:
Drainage;
Duodenal Diseases/*diagnosis/pathology/surgery;
Endoscopy, Digestive System;
Female;
Gastrointestinal Hemorrhage/*etiology/therapy;
Hematoma/*diagnosis/pathology/surgery;
Humans;
Intestinal Obstruction/*etiology/therapy;
Middle Aged;
Tomography, X-Ray Computed
- From:Journal of Korean Medical Science
2009;24(1):179-183
- CountryRepublic of Korea
- Language:English
-
Abstract:
Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
