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Intramural Hematoma of the Duodenum

Intramural Hematoma of the Duodenum Abstract • Intramural duodenal hematoma in children is one of the least common injuries encountered. Because of the rarity of this problem, there has been little conformity of opinion as to the relative merits of operative vs nonoperative management. We reviewed 182 cases of this condition, of which 168 were taken from the English literature and 14 from our hospital. Pancreatitis was the most common associated intra-abdominal lesion (21%), while central nervous system, skeletal, and thoracic injuries (5%) accounted for the major extra-abdominal injuries. Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively. The average hospitalization was 14 days for the surgical group and 11 days for the conservative group. There were 18 complications in the surgical group. It appears that most patients with intramural duodenal hematoma would respond well to conservative management. Surgery should be reserved for those cases that remain obstructed over seven to ten days or have evidence of perforation. (Arch Surg 1988;123:54-58) References 1. Kaufman RA, Towbin R, Babcock DS, et al: Upper abdominal trauma in children: Imaging evaluation . Am J Roentgenol 1984;142:449-460.Crossref 2. Wooley MM, Mahour GH, Sloan T: Duodenal hematoma in infancy and childhood . Am J Surg 1978;136:8-14.Crossref 3. Touloukian RJ: Protocol for the nonoperative treatment of obstructing duodenal hematoma during childhood . Am J Surg 1983;145:330-334.Crossref 4. Adler L, Stulberg HJ: Intramural hematoma of the duodenum . West J Med 1969;110:319-321. 5. Anderson A, Bergdahl L: Intramural hematoma of the duodenum in children: Review of literature and report of two cases . Am Surg 1973;39: 402-405. 6. Babitt DP, Hussain MI, Gavino P, et al: Intramural duodenal hematoma in children . AJDC 1968;115:37-42. 7. Bailey WC, Akers DR: Traumatic intramural hematoma of the duodenum in children: A report of five cases . Am J Surg 1965;110:695-703.Crossref 8. Berry J, Guiseppi PL: Traumatic rupture of the intestine, with a case of recovery after operation and an analysis of the 132 cases that have occurred in ten London hospitals during the last 15 years (1893-1907) . J R Soc Med 1909;2:1-24. 9. Bertelsen S, Suhr P: Intramural haematoma of the duodenum . Acta Chir Scand 1964;128:556-563. 10. Bush AK: Intramural hematoma of the duodenum . W Va Med J 1969;65:395-398. 11. Caird DM, Ellis H: Intramural haematoma of the duodenum: A report of a case and a review of the literature . Br J Surg 1958;45:389-390.Crossref 12. Darby RE, Johnson HF, Till EW: Preoperative diagnosis of intramural hematoma . J Pediatr 1968;72:393-396.Crossref 13. Davis DR, Thomas CY: Intramural hematoma of the duodenum and jejunum: A cause of high intestinal obstruction: A report of three cases due to trauma . Ann Surg 1961;153:394-398.Crossref 14. Devroede GJ, Tirol FT, Lo Russo VA, et al: Intramural hematoma of the duodenum and jejunum . Am J Surg 1966;112:947-954.Crossref 15. Felson B, Levin EJ: Intramural hematoma of the duodenum: A diagnostic roentgen sign . Radiology 1954;63:823-829. 16. Freeark RJ, Corley RD, Norcross WJ, et al: Intramural hematoma of the duodenum . Arch Surg 1966;92:463-475.Crossref 17. Garfinkel B, Waleson M, Furst NJ: Hematoma of the duodenum: Report of a surgically proved case . Am J Surg 1958;95:484-486.Crossref 18. Ghosh S, Walker BQ, McKenna CM: Traumatic intramural hematoma of the duodenum . Arch Surg 1968;96:959-962.Crossref 19. Glass GC: Hemorrhage in a newly born infant causing intestinal and biliary obstruction: Report of a case with necroscopy . AJDC 1937;54: 1052-1056. 20. Godling MR, De Jong P, Parker JW: Intramural hematoma of the duodenum . Ann Surg 1963;157:573.Crossref 21. Grosfeld JL, Cooney DR: Pancreatic and gastrointestinal trauma in children . Pediatr Clin North Am 1975;22:365. 22. Hewetson CT: Closed injuries to the duodenum . Br Med J 1971;2:775.Crossref 23. Hill MC: Roentgen diagnosis of duodenal injuries . Am J Roentgenol 1965;94:356-361. 24. Holgersen LO, Bishop HC: Nonoperative treatment of duodenal hematoma in childhood . J Pediatr Surg 1977;12:11.Crossref 25. Izant RJ, Drucker WR: Duodenal obstruction due to intramural hematomata in children . J Trauma 1964;4:797-813.Crossref 26. Jones WR, Hardin WJ, Davis JT, et al: Intramural hematoma of the duodenum: A review of the literature and case reports . Ann Surg 1971;173: 534-544.Crossref 27. Judd DR, Taybi H, King H: Intramural hematoma of the small bowel: A report of two cases and a review of the literature . Arch Surg 1964;89: 527-535.Crossref 28. Lampert EG, Goodfellow JG, Wachowski TJ: Traumatic subserosal hemorrhage causing small-bowel obstruction . Ann Surg 1954;140:768-770. 29. Liverud K: Hematoma of the jejunum with subileus . Acta Radiol 1948;30:163-168.Crossref 30. Lushbough BC, Friefeld S, Primrose J: Intramural hematoma of the duodenum: A case report and literature review . SD J Med 1979;32:31. 31. Magladry GW, Mathewson C: Duodenal obstruction due to trauma . Stanford Med Bull 1954;12:205-206. 32. Mahboubi S, Kaufmann HJ: Intramural duodenal hematoma in children: The role of the radiologist in its conservative management . Gastrointest Radiol 1976;1:167-171.Crossref 33. Mahour GH, Wooley MM, Gans SL, et al: Duodenal hematoma in infancy and childhood . J Pediatr Surg 1971;6:153-160.Crossref 34. Margolis IB, Carnazzo AJ, Finn MP: Intramural hematoma of the duodenum . Am J Surg 1976;132:779-783.Crossref 35. Mathewson C, Morgan R: Intramural hematoma of the duodenum: A clinical entity . Am J Surg 1966;112:299-307.Crossref 36. Maull KI, Fallahzadeh H, Mays ET: Selective management of posttraumatic obstructing intramural hematoma of the duodenum . Surg Gynecol Obstet 1978;146:221-224. 37. McClelland JR, Thistlethwaite JR, Gerwig WH: Obstruction of distal duodenum due to intramural hemorrhage . Am Surg 1958;24:367-370. 38. McIntyre JA, McIntyre JA: Acute duodenal obstruction secondary to hematoma . Can J Surg 1962;5:324-328. 39. Meadows JA: X-ray evaluation of duodenal trauma in children . J Med Assoc Ala 1969;38:801-810. 40. Mestel AL, Trusler GA, Thomson SA, et al: Acute obstruction of small intestine secondary to hematoma in children . Arch Surg 1969;78: 25-32.Crossref 41. Mirov AG: Intramural hematoma of the duodenum . Surgery 1962;51: 434-436. 42. Moore SW, Erlandson ME: Intramural hematoma of the duodenum . Ann Surg 1963;157:798-809.Crossref 43. Neuhauser EBD: Duodenal hematoma . Postgrad Med 1969;45:57-59.Crossref 44. Nielsen IM: Intramural haematoma of the duodenum treated conservatively: A report of a case . Acta Chir Scand 1980;146:303-305. 45. Pester GH, Peartree P: Traumatic intramural hematoma of the duodenum . Am J Surg 1958;96:568-570.Crossref 46. Reinertson MW: Intramural hematoma of the duodenum: A case report . J Iowa Med Soc 1977;67:175-177. 47. Resnicoff SA, Morton JH: Changing concepts concerning intramural duodenal hematomas . J Trauma 1969;9:561-576.Crossref 48. Rothman D: Duodenal hematoma . J Med Soc NJ 1981;78:50. 49. Sanidad P, Miller HL: Small-bowel submucosal haematoma: A conservative attitude . S Afr Med J 1970;44:811-814. 50. Schonk JWM: Intramural hematoma of the duodenum . Arch Chir Neerl 1974;26:87-90. 51. Shannon R: Traumatic intramural haematoma of the duodenum . Aust NZ J Surg 1962;32:28.Crossref 52. Sloane DR, Clowes GJ: Traumatic intramural haematoma of the duodenum . Med J Aust 1968;2:1184-1185. 53. Snider HR: Acute duodenal obstruction secondary to intramural hematoma . Surgery 1956;39:860-864. 54. Spencer R, Bateman JD, Horn PL: Intramural hematoma of the intestine: A rare cause of intestinal obstruction . Surgery 1957;41:794-804. 55. Steger B, Worley JW: Intramural hematoma of the duodenum . J Lancet 1965;85:495-497. 56. Stewart DR, Byrd CL, Schuster SR: Intramural hematomas of the alimentary tract in children . Surgery 1970;68:550-557. 57. Stirk DI: Case of subserous duodenal haematoma . Br Med J 1953;1: 712.Crossref 58. Swaiman KF, Root JF, Raile RB: The 'coil spring' sign and intramural hematoma of the proximal small intestine . AJDC 1958;95:413-416. 59. Tank ES: Blunt abdominal trauma in infancy and childhood . J Trauma 1968;8:439-448.Crossref 60. Trippestad A: Traumatic intramural haematoma of the duodenum: Report of a case . Acta Chir Scand 1966;131:183-186. 61. Tudor RB, Tolstedt GE: Traumatic intramural hematoma of the duodenum in a child , abstracted. Gastroenterology 1976;70:A-86/944. 62. Vargish T, Urdaneta LF, Cram AE, et al: Duodenal trauma in the rural setting . Am Surg 1983;49:211-213. 63. Vellacott KD: Intramural haematoma of the duodenum . Br J Surg 1980;67:36-38.Crossref 64. Watanabe LM, Inouye MR: Duodenal obstruction due to intramural hematoma: Review of the literature and report of a case . West J Med 1956;85:254-256. 65. Webb AJ, Taylor JJ: Traumatic intramural haematoma of the duodenum . Br J Surg 1967;54:50-56.Crossref 66. Yadav K, Sharma AK, Pathak IC: Duodenal injury following blunt abdominal trauma: A case report . Indian J Pediatr 1979;46:330-331.Crossref 67. Wallenfels K, Foldi P, Niermann H, et al: The enzymic synthesis by trans-glucosylation of a homologous series of glycosidically substituted malto-oligosaccharides and their use as amylase substrates . Carbohydr Res 1978;61:359.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Intramural Hematoma of the Duodenum

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400250064011
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Abstract

Abstract • Intramural duodenal hematoma in children is one of the least common injuries encountered. Because of the rarity of this problem, there has been little conformity of opinion as to the relative merits of operative vs nonoperative management. We reviewed 182 cases of this condition, of which 168 were taken from the English literature and 14 from our hospital. Pancreatitis was the most common associated intra-abdominal lesion (21%), while central nervous system, skeletal, and thoracic injuries (5%) accounted for the major extra-abdominal injuries. Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively. The average hospitalization was 14 days for the surgical group and 11 days for the conservative group. There were 18 complications in the surgical group. It appears that most patients with intramural duodenal hematoma would respond well to conservative management. Surgery should be reserved for those cases that remain obstructed over seven to ten days or have evidence of perforation. (Arch Surg 1988;123:54-58) References 1. Kaufman RA, Towbin R, Babcock DS, et al: Upper abdominal trauma in children: Imaging evaluation . Am J Roentgenol 1984;142:449-460.Crossref 2. Wooley MM, Mahour GH, Sloan T: Duodenal hematoma in infancy and childhood . Am J Surg 1978;136:8-14.Crossref 3. Touloukian RJ: Protocol for the nonoperative treatment of obstructing duodenal hematoma during childhood . Am J Surg 1983;145:330-334.Crossref 4. Adler L, Stulberg HJ: Intramural hematoma of the duodenum . West J Med 1969;110:319-321. 5. Anderson A, Bergdahl L: Intramural hematoma of the duodenum in children: Review of literature and report of two cases . Am Surg 1973;39: 402-405. 6. Babitt DP, Hussain MI, Gavino P, et al: Intramural duodenal hematoma in children . AJDC 1968;115:37-42. 7. Bailey WC, Akers DR: Traumatic intramural hematoma of the duodenum in children: A report of five cases . Am J Surg 1965;110:695-703.Crossref 8. Berry J, Guiseppi PL: Traumatic rupture of the intestine, with a case of recovery after operation and an analysis of the 132 cases that have occurred in ten London hospitals during the last 15 years (1893-1907) . J R Soc Med 1909;2:1-24. 9. Bertelsen S, Suhr P: Intramural haematoma of the duodenum . Acta Chir Scand 1964;128:556-563. 10. Bush AK: Intramural hematoma of the duodenum . W Va Med J 1969;65:395-398. 11. Caird DM, Ellis H: Intramural haematoma of the duodenum: A report of a case and a review of the literature . Br J Surg 1958;45:389-390.Crossref 12. Darby RE, Johnson HF, Till EW: Preoperative diagnosis of intramural hematoma . J Pediatr 1968;72:393-396.Crossref 13. Davis DR, Thomas CY: Intramural hematoma of the duodenum and jejunum: A cause of high intestinal obstruction: A report of three cases due to trauma . Ann Surg 1961;153:394-398.Crossref 14. Devroede GJ, Tirol FT, Lo Russo VA, et al: Intramural hematoma of the duodenum and jejunum . Am J Surg 1966;112:947-954.Crossref 15. Felson B, Levin EJ: Intramural hematoma of the duodenum: A diagnostic roentgen sign . Radiology 1954;63:823-829. 16. Freeark RJ, Corley RD, Norcross WJ, et al: Intramural hematoma of the duodenum . Arch Surg 1966;92:463-475.Crossref 17. Garfinkel B, Waleson M, Furst NJ: Hematoma of the duodenum: Report of a surgically proved case . Am J Surg 1958;95:484-486.Crossref 18. Ghosh S, Walker BQ, McKenna CM: Traumatic intramural hematoma of the duodenum . Arch Surg 1968;96:959-962.Crossref 19. Glass GC: Hemorrhage in a newly born infant causing intestinal and biliary obstruction: Report of a case with necroscopy . AJDC 1937;54: 1052-1056. 20. Godling MR, De Jong P, Parker JW: Intramural hematoma of the duodenum . Ann Surg 1963;157:573.Crossref 21. Grosfeld JL, Cooney DR: Pancreatic and gastrointestinal trauma in children . Pediatr Clin North Am 1975;22:365. 22. Hewetson CT: Closed injuries to the duodenum . Br Med J 1971;2:775.Crossref 23. Hill MC: Roentgen diagnosis of duodenal injuries . Am J Roentgenol 1965;94:356-361. 24. Holgersen LO, Bishop HC: Nonoperative treatment of duodenal hematoma in childhood . J Pediatr Surg 1977;12:11.Crossref 25. Izant RJ, Drucker WR: Duodenal obstruction due to intramural hematomata in children . J Trauma 1964;4:797-813.Crossref 26. Jones WR, Hardin WJ, Davis JT, et al: Intramural hematoma of the duodenum: A review of the literature and case reports . Ann Surg 1971;173: 534-544.Crossref 27. Judd DR, Taybi H, King H: Intramural hematoma of the small bowel: A report of two cases and a review of the literature . Arch Surg 1964;89: 527-535.Crossref 28. Lampert EG, Goodfellow JG, Wachowski TJ: Traumatic subserosal hemorrhage causing small-bowel obstruction . Ann Surg 1954;140:768-770. 29. Liverud K: Hematoma of the jejunum with subileus . Acta Radiol 1948;30:163-168.Crossref 30. Lushbough BC, Friefeld S, Primrose J: Intramural hematoma of the duodenum: A case report and literature review . SD J Med 1979;32:31. 31. Magladry GW, Mathewson C: Duodenal obstruction due to trauma . Stanford Med Bull 1954;12:205-206. 32. Mahboubi S, Kaufmann HJ: Intramural duodenal hematoma in children: The role of the radiologist in its conservative management . Gastrointest Radiol 1976;1:167-171.Crossref 33. Mahour GH, Wooley MM, Gans SL, et al: Duodenal hematoma in infancy and childhood . J Pediatr Surg 1971;6:153-160.Crossref 34. Margolis IB, Carnazzo AJ, Finn MP: Intramural hematoma of the duodenum . Am J Surg 1976;132:779-783.Crossref 35. Mathewson C, Morgan R: Intramural hematoma of the duodenum: A clinical entity . Am J Surg 1966;112:299-307.Crossref 36. Maull KI, Fallahzadeh H, Mays ET: Selective management of posttraumatic obstructing intramural hematoma of the duodenum . Surg Gynecol Obstet 1978;146:221-224. 37. McClelland JR, Thistlethwaite JR, Gerwig WH: Obstruction of distal duodenum due to intramural hemorrhage . Am Surg 1958;24:367-370. 38. McIntyre JA, McIntyre JA: Acute duodenal obstruction secondary to hematoma . Can J Surg 1962;5:324-328. 39. Meadows JA: X-ray evaluation of duodenal trauma in children . J Med Assoc Ala 1969;38:801-810. 40. Mestel AL, Trusler GA, Thomson SA, et al: Acute obstruction of small intestine secondary to hematoma in children . Arch Surg 1969;78: 25-32.Crossref 41. Mirov AG: Intramural hematoma of the duodenum . Surgery 1962;51: 434-436. 42. Moore SW, Erlandson ME: Intramural hematoma of the duodenum . Ann Surg 1963;157:798-809.Crossref 43. Neuhauser EBD: Duodenal hematoma . Postgrad Med 1969;45:57-59.Crossref 44. Nielsen IM: Intramural haematoma of the duodenum treated conservatively: A report of a case . Acta Chir Scand 1980;146:303-305. 45. Pester GH, Peartree P: Traumatic intramural hematoma of the duodenum . Am J Surg 1958;96:568-570.Crossref 46. Reinertson MW: Intramural hematoma of the duodenum: A case report . J Iowa Med Soc 1977;67:175-177. 47. Resnicoff SA, Morton JH: Changing concepts concerning intramural duodenal hematomas . J Trauma 1969;9:561-576.Crossref 48. Rothman D: Duodenal hematoma . J Med Soc NJ 1981;78:50. 49. Sanidad P, Miller HL: Small-bowel submucosal haematoma: A conservative attitude . S Afr Med J 1970;44:811-814. 50. Schonk JWM: Intramural hematoma of the duodenum . Arch Chir Neerl 1974;26:87-90. 51. Shannon R: Traumatic intramural haematoma of the duodenum . Aust NZ J Surg 1962;32:28.Crossref 52. Sloane DR, Clowes GJ: Traumatic intramural haematoma of the duodenum . Med J Aust 1968;2:1184-1185. 53. Snider HR: Acute duodenal obstruction secondary to intramural hematoma . Surgery 1956;39:860-864. 54. Spencer R, Bateman JD, Horn PL: Intramural hematoma of the intestine: A rare cause of intestinal obstruction . Surgery 1957;41:794-804. 55. Steger B, Worley JW: Intramural hematoma of the duodenum . J Lancet 1965;85:495-497. 56. Stewart DR, Byrd CL, Schuster SR: Intramural hematomas of the alimentary tract in children . Surgery 1970;68:550-557. 57. Stirk DI: Case of subserous duodenal haematoma . Br Med J 1953;1: 712.Crossref 58. Swaiman KF, Root JF, Raile RB: The 'coil spring' sign and intramural hematoma of the proximal small intestine . AJDC 1958;95:413-416. 59. Tank ES: Blunt abdominal trauma in infancy and childhood . J Trauma 1968;8:439-448.Crossref 60. Trippestad A: Traumatic intramural haematoma of the duodenum: Report of a case . Acta Chir Scand 1966;131:183-186. 61. Tudor RB, Tolstedt GE: Traumatic intramural hematoma of the duodenum in a child , abstracted. Gastroenterology 1976;70:A-86/944. 62. Vargish T, Urdaneta LF, Cram AE, et al: Duodenal trauma in the rural setting . Am Surg 1983;49:211-213. 63. Vellacott KD: Intramural haematoma of the duodenum . Br J Surg 1980;67:36-38.Crossref 64. Watanabe LM, Inouye MR: Duodenal obstruction due to intramural hematoma: Review of the literature and report of a case . West J Med 1956;85:254-256. 65. Webb AJ, Taylor JJ: Traumatic intramural haematoma of the duodenum . Br J Surg 1967;54:50-56.Crossref 66. Yadav K, Sharma AK, Pathak IC: Duodenal injury following blunt abdominal trauma: A case report . Indian J Pediatr 1979;46:330-331.Crossref 67. Wallenfels K, Foldi P, Niermann H, et al: The enzymic synthesis by trans-glucosylation of a homologous series of glycosidically substituted malto-oligosaccharides and their use as amylase substrates . Carbohydr Res 1978;61:359.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jan 1, 1988

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