Intramural duodenal hematoma secondary to pancreatitis: case report and review of the literature

ABSTRACT CONTEXT: Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis. CASE REPORT: A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later. CONCLUSION: Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.

【摘要背景】自发性十二指肠壁内血肿（intramural duodenal hematoma）较为少见，通常与凝血病（coagulopathy）、抗凝治疗（anticoagulant therapy）及内镜操作（endoscopic procedures）相关。本研究旨在报告一例由慢性胰腺炎急性发作引发的十二指肠壁内血肿病例。
【病例报告】一名46岁男性慢性酒精性胰腺炎患者，因腹痛、黑便（melena）及血红蛋白水平降低入院。检查发现其存在伴活动性出血的十二指肠壁内血肿，遂需实施选择性血管栓塞术（selective angioembolization）。患者病情进展出现十二指肠穿孔（perforated duodenum），随后接受了幽门（pylorus）旷置联合Roux-en-Y胃空肠吻合术（Roux-en-Y gastrojejunostomy）的剖腹手术（laparotomy）。术后9天患者出院。
【结论】十二指肠壁内血肿是胰腺炎的罕见并发症。选择性栓塞术是胰腺炎出血性并发症的首选治疗方案，但需警惕内脏缺血（visceral ischemia）与穿孔的风险。