Duodenal hematoma. Critical analysis of recent treatment technics

Analysis of the fifty-six cases of duodenal hematoma reported since 1966 shows a significant rise in incidence, with uncertainty regarding the most appropriate approaches to therapy. The diagnosis can generally be made by recognizing the "coil spring" sign on upper gastrointestinal series. Thirty-four per cent of the patients reviewed were treated successfully with conservative management. Sixty-two per cent were treated surgically. Fifty-one per cent of the surgical patients were treated by simple evacuation of the hematoma, and 12 per cent of these required reoperation for recurrent obstruction. Forty per cent of the surgical patients were treated by evacuation and gastrojejunostomy, and 21 per cent of these required reoperation for marginal ulceration. A previously unreported case is presented and a new surgical approach utilizing gastroduodenostomy is described, which is believed to offer potentially less risk of subsequent marginal ulceration or recurrent duodenal obstruction.