Intramural hematoma of the duodenum
T. C. Jewett Jr, V. Caldarola, M. P. Karp, J. E. Allen and D. R. Cooney
Department of Surgery, State University of New York, Buffalo.
Intramural duodenal hematoma in children is one of the least common
injuries encountered. Because of the rarity of this problem, there has been
little conformity of opinion as to the relative merits of operative vs
nonoperative management. We reviewed 182 cases of this condition, of which
168 were taken from the English literature and 14 from our hospital.
Pancreatitis was the most common associated intra-abdominal lesion (21%),
while central nervous system, skeletal, and thoracic injuries (5%)
accounted for the major extra-abdominal injuries. Hemophilia, von
Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7
cases and played a major role in the prognosis. Of these cases, 121
patients were treated surgically and 61 conservatively. The average
hospitalization was 14 days for the surgical group and 11 days for the
conservative group. There were 18 complications in the surgical group. It
appears that most patients with intramural duodenal hematoma would respond
well to conservative management. Surgery should be reserved for those cases
that remain obstructed over seven to ten days or have evidence of
perforation.
