Duodenal hematoma

Background

• Relatively uncommon, occurs most frequently in children after blunt abdominal trauma
  • May also occur as a complication of endoscopy
• Diagnosis difficult as symptoms often delayed
• Estimated mortality associated with duodenal injury ranges from 5 to 30%

Clinical Features

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:
  • 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
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Evaluation

CT showing an 11 x 5 cm intramural duodenal hematoma secondary to pancreatitis (not seen).

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, 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

• Abdominal trauma