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Post-traumatic intramural duodenal hematoma in children
Miguel Iuchtman1, Tzvi Steiner, Tzvi Faierman
1Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
The Israel Medical Association Journal : IMAJ
|March 21, 2006
Summary
Pediatric intramural duodenal hematoma (IDH) diagnosis and treatment can be delayed. Conservative management is often successful, but awareness is key to reducing surgical intervention for this condition.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Intramural duodenal hematoma (IDH) causes slow obstruction, often delaying diagnosis.
- Current diagnostic and therapeutic strategies for IDH require review.
Purpose of the Study:
- To outline diagnostic and therapeutic approaches for pediatric IDH.
Main Methods:
- Retrospective review of 12 pediatric patients with post-traumatic IDH (1986-2000).
- Exclusion of 3 patients with clotting disorders.
- Analysis of diagnostic intervals and treatment decisions for the remaining 9 patients.
Main Results:
- The interval from admission to diagnosis for IDH ranged from 24 hours to 6 days.
- Five patients had associated traumatic pancreatitis.
- Seven patients (78%) resolved with conservative management; two required surgery.
- All patients recovered without long-term complications.
Conclusions:
- IDH presents complex clinical and therapeutic challenges in children.
- Common causes include bicycle handlebars, road accidents, and sports trauma; child abuse must be considered.
- Traumatic pancreatitis frequently co-occurs with IDH.
- Gastroduodenal endoscopy can aid diagnosis in ambiguous cases.
- Increased surgeon awareness is crucial to minimize diagnostic delays and surgical decompression necessity.
