Intramural duodenal hematoma and hemoperitoneum after endoscopic treatment in a patient with chronic renal failure on hemodialysis: a case report

Abstract

Introduction: An intramural duodenal hematoma is a rare but recognized complication that usually develops after abdominal trauma, predominantly in children and young adults.

Case presentation: We report the case of a patient that developed an intramural duodenal hematoma after endoscopic treatment for a bleeding ulcer who also was undergoing conventional hemodialysis for chronic renal failure associated with lupus nephritis. A hemoperitoneum and near-total duodenal obstruction developed but spontaneously resolved with conservative treatment.

Conclusion: Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

Figure 1

Initial endoscopic findings revealed bleeding ulcers of the duodenum that were hemoclipped.

Figure 2

CT of the abdomen demonstrates a mass with a filling defect in the second portion of the duodenum and marked narrowing of the lumen of the third portion of the duodenum (A), and the largest part of the hematoma in diameter (B).

Figure 3

Follow-up endoscopy shows a near-total obstruction of the duodenal lumen by the hematoma.

Figure 4

Upper gastrointestinal series with gastrograffin reveals the hematoma compressing the second portion of the duodenum and the partial passage of gastrograffin via a near-totally occluded duodenal lumen without leakage outside.

Figure 5

Follow-up CT of the abdomen 4 weeks post-endoscopy demonstrates partial regression of the hematoma.

Figure 6

Follow-up CT of the abdomen 12 weeks post-endoscopy demonstrates the decreased size of the hematoma.