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Nonoperative treatment of duodenal hematomata in childhood
Insights
Blunt abdominal trauma can cause duodenal obstruction due to intramural hematoma. Most pediatric cases can be successfully treated non-surgically with nasogastric suction and fluids.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Blunt abdominal trauma can lead to intramural hematoma.
- Intramural hematoma can cause complete duodenal obstruction, particularly in children.
- Symptoms include abdominal pain, vomiting, and tenderness, often following seemingly minor trauma.
Purpose of the Study:
- To review the experience of managing duodenal obstruction caused by intramural hematoma in children.
- To evaluate the effectiveness of non-surgical management strategies.
Main Methods:
- Retrospective review of nine pediatric patients with duodenal obstruction due to intramural hematoma.
- Assessment of management strategies, including nasogastric suction, fluid administration, and surgical intervention.
Main Results:
- Eight out of nine patients were successfully managed non-surgically.
- Non-surgical management involved nasogastric suction and parenteral fluid administration.
- One patient required surgical evacuation of the hematoma.
Conclusions:
- Non-surgical management is highly effective for duodenal obstruction secondary to intramural hematoma in children.
- Prompt diagnosis via upper gastrointestinal x-rays is crucial.
- Conservative treatment should be considered the primary approach.
Abstract:
Blunt abdominal trauma, often apparently trivial in nature, may produce intramural hematoma causing complete duodenal obstruction. A child with abdominal pain, persistent vomiting and upper abdominal tenderness should be carefully questioned for a history of trauma. Prompt upper gastrointestinal x-rays will allow early and definitive diagnosis. Previously recommended treatment varies from immediate surgical intervention to observation followed by exploratory laparotomy at a later date. We have treated nine patients with duodenal obstruction caused by intramural hematoma of which eight were successfully managed with nasogastric suction and parenteral fluid administration. One patient had the hematoma evacuated at surgery. This report reviews our experience.