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April 1966

Intramural Hematoma of the Duodenum

Author Affiliations

From the departments of surgery of Cook County Hospital, Northwestern University Medical School, the University of Illinois College of Medicine, and Hektoen Institute for Medical Research at Cook County Hospital, Chicago.

Arch Surg. 1966;92(4):463-475. doi:10.1001/archsurg.1966.01320220019004

THE EXTRAVASATION of blood into the wall of the duodenum is an uncommon consequence of blunt abdominal trauma. Although fewer than 75 cases of symptomatic duodenal hematomas are recorded in the world literature,2-53,55 all but 12 were encountered during the past decade. Further evidence of a recent and striking increase in incidence is the present report on nine patients seen at Cook County Hospital, Chicago, during the past six years. This is the largest reported series of intramural hematomas of the duodenum and suggests the need for greater understanding of the diverse clinical radiologic and pathologic features of this condition.

Pathogenesis  Most, if not all duodenal hematomas are the result of trauma. A variety of forces, often mild in intensity, have been implicated in the development of intestinal injury. Studies by Williams and Sargent53 suggest that a compression of the wall caught between two opposing surfaces is the

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