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Virtual Pediatric Hospital: Paediapaedia: Duodenal Intramural Hematoma Paediapaedia: Gastrointestinal Diseases

Duodenal Intramural Hematoma

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Has variable abdominal pain with recurrent vomiting. The patient can also have concurrent pancreatitis and pseudocyst formation.

Etiology/Pathophysiology:
Result of blunt abdominal trauma to the epigastrium such as from handlebars, hockey sticks, fist and foot. The duodenum is pressed between the anterior abdominal wall and the vertebral column with subsequent contusion and hemorrhage of the bowel wall. The distal duodenum and duodenal jejunal junction is especially susceptible to damage because it is fixed in position. The hematoma usually enlarges slowly over hours and days and then obstructs the bowel. Atraumatic small bowel hematomas can be due to blood dyscrasias or Henoch-Schonlein-Purpura.

Pathology:
Not applicable

Imaging Findings:
The abdominal plain film demonstrates a gastric outlet or duodenal obstruction and there may be a suggestion of a mass compressing the greater curvature of the stomach or the transverse colon.

On an upper GI exam, in the transverse portion of the duodenum, proximally thickening of mucosal folds is seen secondary to intramural blood, and distally a smooth intramural mass is seen that widens the duodenum lumen and crowds the valvulae conniventes and produces a classical coiled spring appearance.

DDX:

References:
See References Chapter.

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