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January 19, 2009

Is It Truly a Spontaneous Duodenal Hematoma?

Arch Surg. 2009;144(1):94. doi:10.1001/archsurg.2008.513

I read with great interest Weil and colleagues’1 article that described a rare case of upper gastrointestinal obstruction caused by a spontaneous duodenal hematoma, and I applaud their thorough review and historical perspective. As described in their article, the patient underwent a major hepatobiliary procedure 18 months prior to presentation. This brings into question the hematoma's spontaneous nature, which is further evidenced by the surgical clips seen adjacent to the hematoma in the first figure in the article. Following this train of thought, one may instead view this as a delayed duodenal hematoma. While this distinction would most likely not have altered their successful treatment approach, I wonder why this was presumed to be of a spontaneous cause rather than one of a slowly expanding, indolent type presenting as a late postoperative complication.

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