Successful endoscopic decompression for intramural duodenal hematoma with gastric outlet obstruction complicating acute pancreatitis

Abstract

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

Keywords: Gastric outlet obstruction; Intramural duodenal hematoma; Successful endoscopic decompression.

Fig. 1

Computed tomography findings. (A) The arrow indicates a highly attenuated mass narrowing the lumen and major distension of the stomach. (B) Blank arrow indicates mild pancreatic swelling with peripancreatic infiltration.

Fig. 2

Endoscopic findings. (A) Tiny erosion on the surface of the duodenal hematoma, suggesting the presence of a fistula between the duodenal lumen and hematoma. (B) Endoscopic decompression for intramural duodenal hematoma through the fistula.

Fig. 3

Follow-up computed tomography of the abdomen showing a decrease in the mass lesion.

Fig. 4

Follow-up endoscopy showing the remaining small ulcer on the duodenal bulb.