Duodenal and rectal hematomas complicating endoscopic biopsy: use of sonography in pediatrics.
Dunkin David,Benkov Keith J,Rosenberg Henrietta Kotlus
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVE:Intramural duodenal hematomas (IDHs) after nontherapeutic endoscopic biopsy are rare. Rectal hematomas (RHs) have not been reported previously. A review of the literature revealed 18 cases of IDHs. METHODS:We reviewed 3 cases that occurred within a 4-month period at our institution. RESULTS:We report a series of 3 cases occurring within a 4-month period. In addition, we report a concurrent RH in 1 of these cases. After becoming symptomatic, 2 of these patients had a diagnosis by computed tomography, the third by sonography. All patients had conservative management and were followed with sonography. CONCLUSIONS:Sonography was found to be an accurate, safe, and nonionizing way to diagnose and follow hematomas in pediatric patients.
Postendoscopic duodenal hematoma in children: ultrasound diagnosis and follow-up.
Dumitriu Dana,Menten Renaud,Smets Françoise,Clapuyt Philippe
Journal of clinical ultrasound : JCU
Intramural duodenal hematomas have most frequently been reported in children in a traumatic setting. We present two cases of duodenal hematoma that occurred after upper gastrointestinal tract endoscopy with biopsy in children without significant prior medical history. The diagnosis was made by ultrasound, in correlation with the clinical presentation. Because the patients were hemodynamically stable, they were treated conservatively and the regression of the hematoma was followed up with ultrasound until its complete resolution. These cases demonstrate the risks of endoscopy, which are not to be neglected even in children without impaired coagulation, and the manner in which ultrasound can provide the correct diagnosis and follow-up.
Duodenal hematoma following EGD: comparison with blunt abdominal trauma-induced duodenal hematoma.
Sahn Benjamin,Anupindi Sudha A,Dadhania Neha J,Kelsen Judith R,Nance Michael L,Mamula Petar
Journal of pediatric gastroenterology and nutrition
BACKGROUND:Duodenal hematoma (DH) is a rare complication of esophagogastroduodenoscopy (EGD) with duodenal biopsy and uncommon, but better described following blunt abdominal trauma (BAT). We aimed to describe DH incidence and investigate risk factors for DH development post-EGD and compare its features to those post-BAT. METHODS:Multiple electronic databases were searched for the diagnosis of DH from 2000 to 2012. Inclusion criteria were patients 0 to 21 years of age who developed a DH following EGD with biopsy or BAT. Exclusion criteria were DH secondary to any other mechanism, EGD performed at another medical center, and insufficient information in the electronic medical record to determine treatments or outcomes. RESULTS:A total of 14 post-EGD and 15 post-BAT patients with DH were included in the study. There were 26,905 EGDs with duodenal biopsies performed during the study period, for an incidence of 1:1922 procedures. Thirteen of 14 (93%) post-EGD DH events occurred between 2007 and 2012 (P < 0.001). The proportion of procedures performed under general anesthesia versus moderate sedation, and performed in the supine position versus left lateral decubitus were close to but did not reach statistical significance. DH-related complications and time to hematoma resolution was similar between groups. CONCLUSIONS:In a 13-year study period, 14 patients developed DH after EGD, for an incidence of 1:1922. Method of sedation and supine positioning of the patient during endoscopy warrant further investigation as potential risks. The clinical course and time to recovery with conservative management are similar between patients with EGD and BAT-induced DH.
Idiopathic retroperitoneal haematoma causing duodenal obstruction: a case report and review of literature.
Merali N,Singh G,Ghorpade A,Shirol S,Singh S,Veeramootoo R
Annals of the Royal College of Surgeons of England
Idiopathic retroperitoneal haematoma is a rare clinical entity; resulting duodenal obstruction is even more occult. It can pose a diagnostic challenge due to variable presentations. Timely management requires a high index of suspicion and a multidisciplinary approach. Surgery is indicated in patients refractory to conservative treatment and failure of endoscopic or interventional radiology options. We report an interesting case illustrating the rarity and severity of this condition, with a review of the literature.
Intramural duodenal haematoma with mucosal prolapse causing intestinal obstruction.
Loganathan Arun Kumar,Bal Harshjeet Singh
BMJ case reports
Intramural small bowel haematoma is a rare cause of intestinal obstruction in children. Coagulation disorders or anticoagulant therapy are the most common cause followed by blunt trauma. A one and half-year-old boy, with known case of gastro-oesophageal reflux disease had undergone upper gastrointestinal endoscopy and biopsy. Four days later, he presented to us with clinical features of small bowel obstruction. CT of the abdomen showed features suggestive of haemorrhagic duplication cyst. Explorative laparotomy revealed 15-20 cm of bowel from the third part of the duodenum to proximal jejunum filled with clotted blood and thinned out serosa. There was no evidence of intraluminal blood in the distal bowel loops. Resection of the involved bowel with primary anastomoses was done. Histopathological examination of bowel revealed intramural haematoma associated with prolapse of the mucosa. There was no evidence of duplication cyst or vascular malformations. Postoperative period was uneventful.
[Intramural duodenal hematoma and acute pancreatitis as a complication of diagnostic biopsy of a duodenal 6-year-old boy].
Krzesiek Elżbieta,Iwańczak Barbara,Zaleska-Dorobisz Urszula,Patkowski Dariusz
Developmental period medicine
Hematoma duodenum is a very rare complication of diagnostic endoscopy of the upper gastrointestinal tract when biopsy of the duodenum is performed (average frequency is estimated as 1:1,250 biopsies). Most often, it affects children and young adults without any risk factors. Symptoms result from obstruction of the duodenum and compression of the adjacent structures. Conservative treatment, which consists of parenteral nutrition and aspiration of gastric contents until the absorption of hematoma and patency of the gastrointestinal tract returns, is preferred. This paper describes a 6-year-old boy diagnosed due to short stature and low weight in whom the diagnostic biopsy of the duodenum caused formation of a hematoma in the descending duodenum and led to total ileus and acute pancreatitis. The boy was treated conservatively with good result and complete resolution of symptoms was achived.