João Henrique Botto de Oliveira1, Raiza Samenica Esper1, Rodrigo Campos Ocariz1, Flora Specian Sartori1, Lucas Marcelo Dias Freire2, Elinton Adami Chaim3, Francisco Callejas-Neto4, Everton Cazzo5. 1. MD. Resident Physician, Department of Surgery, Centro Médico de Campinas (CMC), Campinas (SP), Brazil. 2. MD. Attending Physician, Endovascular Surgery Unit, Centro Médico de Campinas (CMC), Campinas (SP), Brazil. 3. MD, PhD. Full Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil. 4. MD, MSc. Assistant Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil. 5. MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/UNICAMP), Campinas (SP), Brazil.
Abstract
CONTEXT: Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. CASE REPORT: A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later. CONCLUSION: Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.
CONTEXT: Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. CASE REPORT: A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later. CONCLUSION: Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.
Authors: Benjamin Schiller; Michael Radke; Christina Hauenstein; Carsten Müller; Christian Spang; Daniel A Reuter; Jan Däbritz; Johannes Ehler Journal: Medicina (Kaunas) Date: 2021-12-22 Impact factor: 2.430