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Intramural hematoma of the alimentary tract in two hemophilic children
Insights
Intramural hematomas in children with hemophilia can arise from mild trauma. Factor VIII inhibitors developed in both cases, complicating treatment and outcomes.
Area of Science:
- Gastroenterology
- Pediatric Hematology
Background:
- Intramural hematomas of the alimentary tract are rare, particularly in children.
- Hemophilia presents unique challenges in managing bleeding complications.
Observation:
- Two hemophilic children developed intramural hematomas: one in the duodenum with retroperitoneal rupture, and another in the colon.
- Both patients developed factor VIII inhibitors during treatment.
Findings:
- The duodenal hematoma case was fatal despite aggressive medical and surgical interventions.
- The colonic hematoma was managed successfully with medical therapy.
- The development of factor VIII inhibitors complicated management in both pediatric patients.
Implications:
- This case series highlights the critical need for careful consideration of trauma in hemophilic children presenting with gastrointestinal bleeding.
- Management strategies for intramural hematomas in hemophilic children require individualized approaches, balancing surgical and medical options.
- The emergence of factor VIII inhibitors underscores the complexity of treating bleeding disorders in this population and necessitates vigilant monitoring.
Abstract:
The occurrence of an intramural hematoma of the alimentary tract is reported in two hemophilic children. In both cases, the hematomas may be the result of a mild unrecognized trauma. The first patient presents large duodenal hematomas with secondary rupture into the retroperitoneal space. Death occurs despite medical and surgical treatment. The second patient presents an intramural hematoma of the colon, which is treated medically. In both cases factor VIII inhibitors developed during the course of therapy. Indications for medical or surgical treatment are discussed.