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J Korean Soc Emerg Med > Volume 21(5); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(5): 713-716.
A Case of Pancreatitis-Induced Intramural Duodenal Hematoma
Jong Seok Lee, Oh Young Kwon, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko
Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea. xrayhong@hanmail.net
Intramural duodenal hematoma (IDH) usually develops following blunt abdominal trauma. Spontaneous IDH is a rare condition that could be caused by anticoagulant therapy, coagulation disorders, or duodenal endoscopy. Here we report a patient with pancreatitis who developed IDH and gastrointestinal obstruction. A 37-year-old man presented to the emergency department with a six-hour history of persistent localized pain over the epigastric area that radiated to his back and was associated with vomiting. A computed tomography scan with multiplanar reformation revealed pancreatitis and collapse of the duodenal loop that was deviated upward by a hematoma. Pancreatitis-induced IDH was diagnosed and conservative treatment was initiated. On the fourth day of his hospital stay, the patient developed unbearable abdominal pain associated with symptoms of small bowel obstruction. During laparotomy, the hematoma was evacuated and gastrojejunostomy was performed to relieve the duodenal obstruction. Pancreatitis-induced IDH is a rare condition causing gastrointestinal obstruction and should be differentiated from other conditions that result in retroperitoneal hematoma.
Key words: Duodenum, Hematoma, Intestinal obstruction, Pancreas
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