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Intramural hematoma of the duodenum
T C Jewett1, V Caldarola, M P Karp
1Department of Surgery, State University of New York, Buffalo.
Insights
Intramural duodenal hematoma in children is rare. Most cases resolve with conservative management, avoiding surgery unless obstruction or perforation occurs.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Trauma Surgery
Background:
- Intramural duodenal hematoma (IDH) is an uncommon pediatric injury.
- Management strategies for IDH lack consensus due to its rarity.
- Associated injuries and coagulopathies can impact prognosis.
Purpose of the Study:
- To review cases of intramural duodenal hematoma in children.
- To compare operative versus nonoperative management outcomes.
- To identify factors influencing treatment decisions and prognosis.
Main Methods:
- A retrospective review of 182 pediatric cases of IDH.
- Data compiled from English literature (168 cases) and a single hospital (14 cases).
- Analysis of associated injuries, hematologic conditions, treatment modalities, and outcomes.
Main Results:
- Pancreatitis was the most frequent intra-abdominal injury (21%).
- Nonoperative management resulted in shorter hospitalizations (11 days) compared to surgery (14 days).
- Surgical intervention had a higher complication rate (18 complications).
Conclusions:
- Conservative management is effective for most pediatric intramural duodenal hematomas.
- Surgery should be reserved for cases with persistent obstruction (7-10 days) or perforation.
- Early identification of associated injuries and coagulopathies is crucial for optimal patient care.
Abstract:
Intramural duodenal hematoma in children is one of the least common injuries encountered. Because of the rarity of this problem, there has been little conformity of opinion as to the relative merits of operative vs nonoperative management. We reviewed 182 cases of this condition, of which 168 were taken from the English literature and 14 from our hospital. Pancreatitis was the most common associated intra-abdominal lesion (21%), while central nervous system, skeletal, and thoracic injuries (5%) accounted for the major extra-abdominal injuries. Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively. The average hospitalization was 14 days for the surgical group and 11 days for the conservative group. There were 18 complications in the surgical group. It appears that most patients with intramural duodenal hematoma would respond well to conservative management. Surgery should be reserved for those cases that remain obstructed over seven to ten days or have evidence of perforation.