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Laparoscopic drainage of a post-traumatic intramural duodenal hematoma in a child
Behrouz Banieghbal1, Cobus Vermaak, Peter Beale
1Division of Pediatric Surgery, Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa. banieghbal@worldonline.co.za
Insights
Duodenal intramural hematoma, a rare injury from blunt abdominal trauma, typically requires non-operative management. This case highlights successful laparoscopic drainage in a pediatric patient who failed conservative treatment.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Trauma Surgery
Background:
- Duodenal intramural hematoma is an uncommon consequence of blunt abdominal trauma.
- Standard management is typically non-operative, focusing on conservative measures.
Observation:
- An 11-year-old boy presented with a duodenal intramural hematoma after blunt abdominal trauma.
- Initial conservative management failed to resolve the hematoma.
Findings:
- Laparoscopic drainage was successfully performed using a four-port approach.
- The procedure involved dissecting the inflammatory mass and evacuating the hematoma via duodenal serosal incision.
- The patient experienced an uneventful recovery and was discharged within 48 hours.
Implications:
- This case demonstrates the feasibility and success of laparoscopic intervention for refractory duodenal intramural hematoma in children.
- It presents a potential minimally invasive surgical option for selected pediatric trauma cases.
- This represents the first reported instance of successful laparoscopic treatment for this condition.
Abstract:
Duodenal intramural hematoma owing to blunt abdominal trauma is a relatively rare condition and is normally managed non-operatively. In this paper, we present the case of an 11-year-old boy with a post-traumatic duodenal hematoma, who after failing conservative management, underwent laparoscopic drainage. A four-port approach in a similar position to the laparoscopic cholecystectomy was used. After disentangling the inflammatory mass, the duodenal serosa was opened by simple hook diathermy and the hematoma evacuated. The child recovered uneventfully and was discharged home 48 hours later. To our knowledge, this is the first time that this condition has been successfully treated laparoscopically.
