A Case of Traumatic Intramural Hematoma of the Duodenum Effectively Treated with Percutaneous Drainage

Abstract

An 18-year-old man had bruises on his abdomen from a road traffic accident. On the next day, he was admitted to our emergency room after he had episodes of vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a low-density area in the descending and transverse portions of the duodenum. He was diagnosed with traumatic intramural hematoma of the duodenum complicated by duodenal obstruction and managed conservatively. However, an abdominal CT on admission day 11 revealed an enlargement of the hematoma towards the abdominal wall. The new CT findings warranted an ultrasound-guided percutaneous drainage, which quickly reduced the size of the hematoma. Most traumatic intramural duodenal hematomas are treated conservatively, but some of such lesions are difficult to treat because of duodenal obstruction. Percutaneous drainage has the advantages of the ability to puncture under ultrasound guidance, observe and clean the drainage, and easily replace the drainage tube. When no complication of injury to surrounding organs exists and a safe puncture route can be secured from the body surface, percutaneous drainage may be an effective option to shorten the treatment period. We report a case of traumatic intramural hematoma of the duodenum, which was effectively treated with percutaneous drainage.