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Post-traumatic intramural duodenal hematoma in children: A single-center experience
Miki Ishikawa1, Tomohide Koyama2, Hirofumi Tomita1
1Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
Post-traumatic intramural duodenal hematomas in children are rare. Surgical intervention is recommended for persistent obstruction or complications like pancreatitis to ensure faster recovery.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Post-traumatic intramural duodenal hematomas are uncommon pediatric injuries.
- Nonoperative management is typical for these cases.
Purpose of the Study:
- To describe optimal treatment strategies for pediatric post-traumatic intramural duodenal hematomas.
- To evaluate outcomes of operative versus nonoperative management.
Main Methods:
- Retrospective review of pediatric patients with duodenal hematomas.
- Data collected from 2010-2024 at a single institution.
Main Results:
- Six patients (median age 11 years) with Grade I or II hematomas were identified.
- Two patients developed secondary pancreatitis and cholestasis, one requiring surgery.
- Conservative management for Grade II injuries resulted in prolonged recovery (20 days).
Conclusions:
- Prolonged nonoperative management is seen in large Grade II hematomas.
- Surgical intervention should be considered for persistent obstruction (>7-10 days).
- Early surgical consideration is advised for cases with secondary pancreatitis or cholestasis to prevent severe complications and promote recovery.
Background:
This study aimed to describe the appropriate treatment for post-traumatic intramural duodenal hematomas, which are relatively rare and usually managed nonoperatively in pediatric patients.
Methods:
A retrospective review of pediatric patients with a post-traumatic intramural duodenal hematoma was conducted at a single institution between 2010 and 2024.
Results:
Five male children and one female child with a median age of 11 (range, 7-14) years and an American Association for the Surgery of Trauma grade I (n = 3) or II (n = 3) intramural duodenal hematoma were identified. Secondary pancreatitis and cholestasis caused by pressure drainage of the papilla of Vater were observed in two patients. One of those patients required laparoscopic drainage of the hematoma. Surgical complications were not observed. Two patients with conservatively treated grade II injuries experienced hematoma shrinkage and resumption of oral intake after 20 days.
Conclusions:
Cases involving large grade II hematomas treated with nonoperative management are prolonged. Surgical intervention should be considered for cases involving obstruction that persists beyond 7-10 days, and especially for those involving secondary pancreatitis or cholestasis, to avoid severe complications and allow early recovery.
