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. 2010 Jul 28;2(7):283-8.
doi: 10.4329/wjr.v2.i7.283.

Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review

Kazue Shiozawa  1 , Manabu Watanabe, Yoshinori Igarashi, Yasushi Matsukiyo, Teppei Matsui, Yasukiyo Sumino
Affiliations

Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review

Kazue Shiozawa et al. World J Radiol. .

Abstract

Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonography and endoscopy, and it was complicated by acute pancreatitis. The lesions resolved with conservative management. We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis. In our patient, acute pancreatitis occurred concurrently with hematoma, probably due to obstruction of the duodenal papilla, or compression of the pancreas caused by the hematoma. The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.

Keywords: Acute pancreatitis; Computed tomography; Intramural duodenal hematoma; Jaundice; Ultrasonography.

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Figures

Figure 1
Figure 1
Abdominal computed tomography revealed an increased density of peripancreatic dirty fat tissue and fluid collection (arrowheads), without (A) and with (C) contrast. Unenhanced computed tomography (B) revealed a slightly hyperdense, spindle-shaped mass, 65 mm in maximum diameter, mainly along the descending part of the duodenum (arrow). This mass showed no contrast enhancement in the arterial phase (arrow) (D).
Figure 2
Figure 2
Abdominal ultrasonography showed a 65 mm × 45 mm heterogeneous mass at the level of the pancreatic head (arrows) (A and B), with a slightly dilated main pancreatic duct (arrowhead) and peripancreatic fluid collection (A).
Figure 3
Figure 3
Gastrointestinal fiberscopy showed the reddish and edematous mucosa in the descending part of the duodenum (A) and luminal narrowing was observed (B).
See this image and copyright information in PMC

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