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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.
Archives of Surgery (Chicago, Ill. : 1960)
|January 1, 1988
Summary
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.