View source for Duodenal hematoma

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==Background==

*Relatively uncommon, occurs most frequently in children after blunt [[Special:MyLanguage/abdominal trauma|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
*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>
*Estimated mortality associated with duodenal injury ranges from 5 to 30% <ref> 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.</ref>


==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:
**[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
**Distension
**[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]
**[[Special:MyLanguage/Hematemesis|Hematemesis]]
**Diminished bowel sounds


==Differential Diagnosis==

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{{Abdominal trauma DDX}}
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==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===

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, [[Special:MyLanguage/IVF|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 [[Special:MyLanguage/abscess|abscess]]
*Duodenal fistula
*Post-traumatic [[Special:MyLanguage/pancreatitis|pancreatitis]]



==See Also==

*[[Special:MyLanguage/Abdominal trauma|Abdominal trauma]]


==External Links==


==References==

<references/>

[[Category:GI]]
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