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Imaging diagnosis and sequential conservative treatment of pediatric traumatic duodenal intraluminal hematoma
Xiaoyan Weng1, Qianqin Zhou2, Zhaofan Qin3
1Ultrasound Department of Women and Children's Hospital Affiliated to Ningbo University, Zhejiang, China.
Insights
Traumatic duodenal intramural hematoma in children is effectively diagnosed with computed tomography (CT) and ultrasound. Conservative management leads to favorable outcomes, improving diagnosis and reducing hospital stays.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Imaging
- Trauma Medicine
Background:
- Traumatic duodenal intramural hematoma is a rare but serious condition in children.
- Accurate and timely diagnosis is crucial for effective management and improved patient outcomes.
Purpose of the Study:
- To investigate the imaging characteristics, diagnostic approaches, and treatment strategies for traumatic duodenal intramural hematoma in pediatric patients.
- To enhance diagnostic accuracy and reduce hospitalization duration for this condition.
Main Methods:
- A retrospective analysis was conducted on five pediatric cases of traumatic duodenal intramural hematoma.
- Computed tomography (CT) was used for initial diagnosis, with magnetic resonance imaging (MRI) and ultrasound employed for follow-up assessments.
Main Results:
- CT revealed characteristic signs like the "ice melting sign" and "fissure sign" without lesion enhancement.
- MRI demonstrated intramural hematomas as protruding masses with lumen stenosis and specific signal intensities.
- Ultrasound effectively monitored hematoma absorption and intestinal obstruction progression.
Conclusions:
- Conservative treatment, including gastrointestinal decompression and nutritional support, yields favorable outcomes for pediatric duodenal intramural hematoma.
- A combination of initial CT diagnosis and serial ultrasound follow-up offers high specificity for managing this condition.
Aim:
To explore the imaging, diagnosis, and treatment of traumatic duodenal intramural hematoma in children, improve diagnostic accuracy, and shorten hospitalization time.
Methods:
A retrospective analysis of five children with traumatic duodenal intramural hematoma.
Results:
One child had a descending duodenal wall hematoma, two had horizontal wall hematomas, one had an ascending wall hematoma, and one case involving both the descending and ascending parts. All five children were initially diagnosed by computed tomography (CT). The typical images showed "ice melting sign" and "fissure sign," with no lesion enhancement. Magnetic resonance imaging (MRI) in two children on follow-up showed spindle-shaped or quasi-circular intestinal walls protruding towards the intestinal lumen, local intestinal lumen stenosis, high signal intensity on T1W1 and uneven high signal intensity on T2W1, with no enhancement of the lesion. All five patients underwent multiple dynamic follow-up examinations using ultrasound, which clearly displayed the structure of the intestinal wall, absorption of hematoma, and the degree of intestinal obstruction.
Conclusion:
Conservative treatment, such as gastrointestinal decompression and intravenous nutrition, for pediatric duodenal wall hematoma has a good prognosis results in favorable outcomes. Initial CT diagnosis combined with multiple ultrasound follow-up has high specificity for the diagnosis and treatment of this disease.