Non-traumatic Intramural Duodenal Hematoma With Acute Pancreatitis in a Nonagenarian: A Case Report

Intramural duodenal hematoma (IDH) is a relatively rare condition typically managed conservatively. Although IDH frequently causes duodenal obstruction, the development of acute pancreatitis (AP) due to ampulla of Vater compression is uncommon. We report the case of non-traumatic IDH in a 90-year-old man receiving anticoagulant therapy, complicated by AP and persistent duodenal obstruction. Imaging studies revealed an intramural hematoma in the descending portion of the duodenum, without evidence of active bleeding. Despite five weeks of conservative management, the obstruction did not improve, and progressive malnutrition was a concern. Therefore, a gastrojejunostomy was performed without hematoma evacuation. The postoperative course was uneventful, and subsequent imaging confirmed spontaneous resolution of the hematoma. This case highlights that IDH can be associated with AP and that gastrojejunostomy without hematoma removal may be a viable surgical option in selected cases with persistent obstruction.