Objective: Describe a patient with Intramural Duodenal Hematoma (IDH) post diagnostic Esophago-Gastro-Duodenoscopy (EGD), and bring this special complication to pediatricians` attention.
Methods: Patient records and literature review.
Results: During investigation of a 14.5 years-old girl with recurrent abdominal pain she underwent elective EGD with duodenal biopsy. About 12 hours post procedure she arrived to our Emergency Room due to acute abdominal pain and recurrent vomiting. She was in good physical state; abdomen was soft, with tenderness on central-right upper abdomen, without peritoneal irritation signs.
Laboratories results showed Hb=11.9g%, Lipase 6478u/l; rest of blood parameters were within normal limits.
An abdominal Ultra-Sound (US) showed some free peritoneal fluid around the spleen. Due to suspected intestinal perforation an abdominal Computerized Tomography (CT) scan was done, showing large IDH at the second part of the duodenum. That finding caused both partially duodenal obstruction and obstructive pancreatitis.
The patient was treated conservatively successfully. While blood loss was minor, weight loss was significant, from 55 to 49 Kg within 2 weeks, although initially she did receive Peripheral Parenteral Nutrition. Weight was regained gradually during 2 months. Duodenal biopsy was normal.
This complication is rare, and more common in children and patients with bone-marrow disorders. It was described in 28 children until 2017, our patient being the 29th.
Conclusion: Children are at higher risk for IDH. They suffer from partial duodenal obstruction, obstructing pancreatitis and partial obstructing biliary drainage.
Diagnosis should be suspected and is made by US/CT.
Almost all children respond to conservative management.
