A case of spontaneous intramural duodenal hematoma in a young African man: Imaging findings

Abstract

Intramural duodenal hematoma has been reported as a rare condition first described by McLauchlan in 1838. It is now thought to be an uncommon condition due to the increase in the number of reported cases in the medical literature. It has been reported to usually occur secondary to blunt trauma mainly in young men and children, with 82% of the patients being younger than 30 years. Association between spontaneous intramural duodenal hematoma and coagulopathy, coagulating drugs, endoscopic procedures, acute pancreatitis, and pancreatic malignancy has been made. We present the case of a 35-year-old African male lumberjack with no known previous history of trauma, risk factors, or associated predisposing condition that presented to our facility with acute abdominal pain and vomiting and diagnosed as spontaneous intramural duodenal haematoma on CT scan and MR imaging with a complete resolution on conservative management.

Keywords: Hemorrhage; Intramural duodenal; Lumberjack; Nonalcoholic; Spontaneous; Young African male.

Fig. 1

(a) Axial and (b) coronal reformatted oral and IV contrast enhanced CT on day of presentation shows 2nd part of duodenum with intramural hyperdensity and enlargement (black arrows). Dilated stomach (white arrow) and prominent common bile duct (solid white arrow) are also seen.

Fig. 2

(a) Axial T2 ssfp (b) Axial T1W (c) Coronal T1W (d) Coronal T2 ssfp images 14 days after CT scan show duodenal haematoma (black arrows).

Fig. 3

Post treatment (10 weeks after presentation) T2W axial MRI shows normal size of duodenum with normal signal indicating resolution of haematoma.