2021 Volume 63 Issue 4 Pages 407-414
A 62-year-old man was admitted to our hospital due to vomiting. Abdominal enhanced computed tomography (CT) showed a large retroperitoneal hematoma, and upper gastrointestinal endoscopy revealed stenosis of the horizontal portion of the duodenum. In addition to nasal gastric tube drainage, we started enteral nutrition after placing a nasal jejunal tube through the ligament of Treitz under fluoroscopic guidance. On hospital day 14, follow-up abdominal enhanced CT revealed a posterior inferior pancreaticoduodenal artery pseudoaneurysm; however, we continued conservative therapy because the hematoma had not increased in size. On hospital day 21, follow-up CT showed that the hematoma had shrunk somewhat. However, upper gastrointestinal endoscopy showed that the duodenal stenosis remained. We therefore performed endoscopic balloon dilation and removed the nasal tubes on hospital day 23. No recurrence of digestive symptoms was noted after he started oral consumption of food on hospital day 28. He was discharged on hospital day 34. In most cases, conservative therapy can improve duodenal stenosis due to retroperitoneal hematoma. However, in some cases, the duodenal stenosis does not improve due to fibrosis, even though the size of the hematoma decreases. Such cases often require surgical management. In our case, we successfully performed endoscopic balloon dilation, and the stenosis improved.
