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Duodenal hematoma after upper endoscopy and biopsy in a 4-year-old girl
Kirsten Bechtel1, R Lawrence Moss, John M Leventhal
1Yale University School of Medicine, New Haven, CT, USA. Kirsten.Bechtel@yale.edu
Insights
Duodenal hematoma is a rare complication following pediatric upper endoscopy. This case highlights the importance of considering child abuse and coagulopathy in children with unexplained duodenal hematomas.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Pediatric Surgery
Background:
- Upper endoscopy with biopsy is a common diagnostic procedure in children.
- Duodenal hematoma is a rare but serious complication of gastrointestinal procedures.
- It is crucial to consider non-accidental trauma in the differential diagnosis of unexplained abdominal injuries in children.
Observation:
- A 4-year-old girl developed a duodenal hematoma after undergoing an upper endoscopy and biopsy.
- The child had no history of abdominal trauma or prior gastrointestinal procedures.
- The presentation was initially attributed to the endoscopic procedure.
Findings:
- The duodenal hematoma was confirmed as a complication of the upper endoscopy and biopsy.
- In the absence of clear trauma, child abuse was considered in the differential diagnosis.
- Coagulopathy was also investigated as a potential contributing factor.
Implications:
- This case underscores the importance of suspecting child abuse in pediatric patients with unexplained duodenal hematomas.
- A comprehensive medical evaluation, including assessment for coagulopathies, is essential.
- Awareness of this rare complication can aid in timely diagnosis and management in pediatric patients.
Abstract:
We describe a 4-year-old girl who developed a duodenal hematoma after upper endoscopy and biopsy. Although rare, duodenal hematoma formation can occur after upper endoscopy and biopsy in otherwise healthy children. A young child presenting with a duodenal hematoma in the absence of a clear mechanism of either previous gastrointestinal procedures or injury to the abdomen should have an extensive evaluation to exclude child abuse. A thorough evaluation for other medical causes, such as a coagulopathy, should be performed simultaneously.
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