Intramural Hematoma of the Duodenum in a Four-Year-Old Child Following a Blunt Bicycle Handlebar Injury: A Case Report

Abstract

Duodenal hematomas are an uncommon occurrence in the pediatric population, most frequently resulting from blunt abdominal trauma. The preferred treatment modality is a non-operative management, which typically includes bowel rest, nasogastric tube, parenteral nutrition, serial laboratory evaluations, and follow-up imaging. Surgical intervention is rare and generally reserved for cases with complications or failure of conservative therapy. Clinical presentation often includes abdominal pain, nausea, and vomiting. Due to the retroperitoneal location of the duodenum, physical examination findings are typically non-specific. Furthermore, imaging studies may yield false-negative results, contributing to delayed diagnosis and increased risk of complications. In this case report, we present a four-year-old patient diagnosed with a large intramural duodenal hematoma and successfully managed with a conservative, non-operative approach.

Keywords: blunt injury; hematoma of duodenum; non-operative; pediatric; trauma.

Figure 1. The ultrasound performed on admission

Ultrasound image showing large hematoma; measurements: diameter 40.2 mm (A, red arrow), width 33.2 mm (B, blue arrow), length 62.5 mm (B, green arrow). The duodenal lumen was not visualized due to external compression caused by a duodenal hematoma.

Figure 2. Computed tomography image showing a hematoma compressing the inferior vena cava (A) and the common hepatic duct (B)

(A) CT image showing a hematoma at the level of the pancreas (red arrow). (B) CT image showing a hematoma located below the head of the pancreas (green arrow).

Figure 3. MRI image demonstrating marked dilation of the common bile duct and pancreatic duct due to compression by hematoma

(A) White arrow indicating duodenal hematoma; (B) White arrow indicating common bile duct; (C) White arrow indicating pancreatic duct. The anatomical location of both ducts predispose them to dilation caused by external compression from the duodenal hematoma demonstrated in the presented image. MRI reveals contusion of the pancreatic head without evdence of pancreatic duct injury.

Figure 4. Follow-up ultrasound on ninth day post-admission

(A) Ultrasound image showing width of the hematoma (17.6 mm) (green arrow) and length of the hematoma (40.4 mm) (red arrow). (B) Ultrasound image showing the diameter of the hematoma (31.6 mm) (blue arrow).

Figure 5. Control ultrasound after four months

(A) Red arrow shows measurement of the hematoma (3.4 mm). (B) Green arrow shows measurement of the hematoma (3.1 mm).