Conservative management of intestinal obstruction by isolated intramural duodenal hematoma. A case reportand review of the literature.

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COD: 2410_07_12_2015_ep Categorie: ,

Francesco D’Arpa, Giuseppina Orlando, Roberta Tutino, Giuseppe Salamone, Emanuele Onofrio Battaglia, Gaspare Gulotta

Ann. Ital. Chir.Published online (EP) 7 December 2015

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The duodenal injuries occur in the 3-5% of blunt abdominal traumas. The isolated intramural duodenal hematoma isa very rare lesion. An early diagnosis and an adequate therapy are crucial because a delay, beyond 24 hours, increasesthe mortality from the 11% to 40%. However, diagnosis is often hindered by a lack of specific symptoms. We report a case of a 21 years-old man with an intestinal obstruction from isolated intramural duodenal hematomaoccurred after a blunt abdominal trauma in a sport competition.The patient was treated conservatively with total parenteral nutrition, gastric decompression and intravenous PPIs. Theprogressive spontaneous resolution of the hematoma was checked with periodical endoscopies.The discharge occurred after three weeks with no early complications. No late complications occurred at one-year follow-up.The endoscopy is a good and safe tool in the management of this intestinal obstructions with the possibility of conserv-ative or interventional treatment.