Intramural duodenal hematoma: clinical course and imaging findings

Abstract

Background: Intramural duodenal hematoma is a rare condition. Different imaging modalities are at hand for diagnosis.

Purpose: To identify patients with intramural duodenal hematoma and report imaging findings and clinical courses.

Material and methods: Typical imaging patterns using ultrasound, computed tomography, and magnetic resonance imaging were carried out on 10 patients.

Results: The mean patient age was 7.5 years. The average disease duration was 13 months. Clinical signs of improvement were observed within 16 days. Residues were still detectable at long-term follow-up.

Conclusion: For patients with intramural duodenal wall hematoma, diagnosis should be considered early. Typical imaging findings should be known to ensure optimal treatment.

Keywords: Abdomen/GI; adults and pediatrics; computed tomography; hemorrhage; small bowel; ultrasound.

Fig. 1.

US of a five-year-old girl with a duodenal wall hematoma: (a) Initial finding with an echogenic mass which presents smaller and more cystic at follow-up (b).

Fig. 2.

Axial contrast-enhanced CT of the pars horizontalis duodeni showing the duodenal wall hematoma (arrows) with a density of 50–60 HU.

Fig. 3.

A 20-year-old man with an acute duodenal wall hematoma. Contrast-enhanced CT scan acquired at primary diagnosis in (a) axial, (b) coronal, and (c) sagittal planes demonstrates the extent of the hematoma (arrows).

Fig. 4.

(a) Axial CT images showing extensive perfusion deficit of the liver tissue. (b) Postoperatively after decompression of the hematoma at the liver hilum reperfusion of the portal vein.

Fig. 5.

Axial low-dose contrast-enhanced CT at follow up: mixed hypo- and hyperdense mass reflecting incomplete resorption with residual clotted hematoma (arrows).

Fig. 6.

(a) Coronal and (b) sagittal CECT showing the complete extent of the hematoma (white arrows). Residual lumen of the duodenum (black arrows) seen best with additional oral contrast.

Fig. 7.

A 20-year-old male patient after deep duodenal biopsy. (a) Coronal T2W image demonstrating the hematoma size and the stenosis of the hepatic duct (arrow) as complication of the duodenal wall hematoma. (b) Axial CE T1 with fat saturation showing the extent of the duodenal wall hematoma.