Double Trouble: Spontaneous Duodenal Hematoma of Pancreatic Origin

摘要

A 55-year-old alcohol-dependent man presented to the hospital for a 6-day history of epigastric pain radiating to the back, associated with nausea and uncontrollable vomiting. He denied any known coagulation disorder, recent abdominal trauma, or endoscopic/surgical intervention. Physical examination revealed scleral icterus, abdominal distention, and epigastric tenderness. Investi­gation identified hyperamylasemia (441 IU/L), high creatinine (6.02 mg/dL), and total serum bilirubin (2.89 mg/dL). Abdominal computed tomography (CT) performed without intravenous contrast enhancement showed duodenal distension with spontaneously hyperdense obstructive lesion in the descending duodenum and changes suggesting the presence of acute pancreatitis (Fig. ). This was suggestive of an obstructive intramural duodenal hematoma (IDH) in the descending duodenum. A nasogastric decompression was performed, and the patient was kept on nil by mouth and treated with intravenous fluid hydration, parenteral nutrition, and proton pump inhibitor. The patient improved with remission of abdominal pain and vomiting as well as recovery of renal function. Three weeks later, abdominal magnetic resonance imaging demonstrated a marked reduction in the size of the IDH (Fig. ).