Duodenal hematoma in pediatric age: a rare case report
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CASE REPORT
Duodenal hematoma in pediatric age: a rare case report Carmela Brillantino1 · Eugenio Rossi1 · Diana Baldari1 · Rocco Minelli2 · Elio Bignardi3 · Giuseppe Paviglianiti4 · Giulia Restivo5 · Maria A. Cangemi6 · Raffaele Zeccolini7 · Massimo Zeccolini8 Received: 4 October 2020 / Accepted: 15 November 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2021
Abstract In pediatric age, duodenal hematoma is rare and generally occurs following a closed abdominal trauma due to the crushing of the duodenum against the rigid plane of the spine; it rarely follows anticoagulant therapy, pancreatitis, bleeding disorders, vasculitis, tumors or upper digestive endoscopy. Duodenal hematoma is a rare cause of obstruction of the upper gastrointestinal tract and acute pancreatitis, and the diagnosis is sometimes difficult and late. On the other hand, the identification of the pathology in its initial stages allows the young patients to be subjected to a conservative treatment that resolves the issue most of the time, thus avoiding surgery. In this article we describe an unusual case of duodenal hematoma, following esophagus-gastro-duodenoscopy, in a 12-year-old boy with Di George syndrome. Keywords Duodenal hematoma · Abdominal mass · Ultrasound · TC · RM
Introduction Duodenal hematoma is a rare condition in children, and most of the cases described in the literature concern young adults under the age of 30 [1, 2]. In 2–5% of cases, it occurs following a closed abdominal trauma due to the compression of the duodenum against the spine. Even less frequently, * Rocco Minelli [email protected] 1
Unit of Radiology and Ultrasound, A.O.R.N. SantobonoPausilipon, Pausilipon Hospital, Naples, Italy
2
Department Life and Health “V. Tiberio”, University of Molise, Francesco De Sanctis st 1, 86100 Campobasso, Italy
3
Unit of Imaging Diagnostics, A.O.R.N. dei Colli, Cotugno Hospital, Naples, Italy
4
UOC Pediatric Radiology PO G. Di Cristina-ARNAS Civico Benefratelli Palermo, Palermo, Italy
5
Department of Sciences for the Promotion of Health and Maternal and Childhood “G. D’Alessandro”, University of Palermo, Palermo, Italy
6
UOC Nest-Pediatrics PO Vittorio Emanuele Castelvetrano, Trapani, Italy
7
Luigi Vanvitelli University, Naples, Italy
8
Unit of Radiology, A.O.R.N. Santobono-Pausilipon, Santobono Hospital, Naples, Italy
it is linked to other causes such as anticoagulant therapy, pancreatitis, bleeding disorders, vasculitis, tumors or upper digestive endoscopy [1–4]. Duodenal hematoma is a rare cause of obstruction of the upper gastrointestinal tract that can be associated with acute pancreatitis and cholestasis; therefore, a timely diagnosis is essential for the prevention of serious complications, such as heart attack and intestinal perforation, pancreatic necrosis, cholangitis, diffuse peritonitis, sepsis, and shock [1–5]. Early recognition of the little patient with duodenal hematoma allows for a conservative treatment, almost always decisive, avoiding surgery [1, 3–6].
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