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Case Reports
. 2025 May 30;17(5):e85113.
doi: 10.7759/cureus.85113. eCollection 2025 May.

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

Olga Gryszkiewicz  1 , Marek Wolski  1
Affiliations
Case Reports

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

Olga Gryszkiewicz et al. Cureus. .

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.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
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
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
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
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
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).
See this image and copyright information in PMC

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