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Intramural duodenal hematoma in children: reappraisal of current management
1Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
Insights
Surgical evacuation is recommended for pediatric intramural duodenal hematomas if conservative management fails. This includes cases with no partial resolution after five days or complete resolution after ten days of treatment.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Intramural duodenal hematomas in children typically result from blunt abdominal trauma.
- Current nonoperative management involves nasogastric suction and parenteral nutrition.
Observation:
- Conservative management failed in three pediatric cases of intramural duodenal hematoma.
- This prompted a reevaluation of nonoperative treatment efficacy.
Findings:
- Surgical evacuation is now recommended for persistent intramural duodenal hematomas.
- Indications for surgery include lack of partial resolution within five days or complete resolution within ten days of conservative care.
Implications:
- This guideline refines treatment strategies for pediatric duodenal hematomas.
- Early surgical consideration may improve outcomes for non-responsive cases.
Abstract:
In children, intramural duodenal hematomas resulting from blunt abdominal trauma are generally managed nonoperatively with nasogastric suction and parenteral nutrition. Experience with three cases in which this form of treatment failed caused us to reappraise its benefits and results. Consequently, we now recommend surgical evacuation of intramural duodenal hematomas for children in whom there is no evidence of partial resolution of the obstruction after five days or of complete resolution after ten days of conservative management.