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[Intramural duodenal hematoma: conservative treatment in six cases (author's transl)]
Insights
Intramural duodenal hematomas in children are typically traumatic. Conservative management is recommended for these hematomas when no other surgical issues are present.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
Background:
- Intramural duodenal hematoma (IDH) is a rare condition in children.
- Etiology is often traumatic but can be associated with coagulopathies or Schönlein-Henoch purpura.
Observation:
- Six pediatric cases of IDH under seven years old were reviewed.
- Literature search identified 143 pediatric cases (<15 years).
- Contrast X-rays, particularly the "spring" sign, are crucial for diagnosis.
Findings:
- Most cases were treated conservatively.
- Three patients underwent surgery for associated conditions (hepatic rupture, appendicitis, intussusception).
- No hematomas were surgically drained; excellent clinical outcomes and oral tolerance were achieved within 3-7 days.
Implications:
- Conservative treatment is the preferred approach for pediatric IDH.
- Surgical intervention is reserved for cases with complications requiring laparotomy.
- Early diagnosis via imaging facilitates successful non-operative management.
Abstract:
Six cases of intramural duodenal hematoma in children less than seven years old are presented. A review of the literature found 143 cases in patients under 15 years. The etiology is traumatic in most cases, although they have also been described in patients with Schönlein-Henoch purpura or coagulation diseases. Contrast X-rays are fundamental elements for diagnosis. The "spring" sign is very valuable. Patients were conservatively treated, although three of them where operated, one for a hepatic rupture and the two other for presumed appendicitis and intussusception respectively. In none was the hematoma drained. Clinical course was excellent and oral tolerance was achieved between three and seven days. Based on this experience and that obtained in the review of the literature, conservative treatment is recommended for intramural duodenal hematomas, when other associated problems needing a laparotomy have been excluded.