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September 1964

Duodenal Obstruction Due to Intramural HematomaPreoperative Diagnosis

Arch Surg. 1964;89(3):441-445. doi:10.1001/archsurg.1964.01320030031005

Duodenal obstruction secondary to an intramural hematoma was first described by McLaughlin in 1838.1 Of the 36 reported cases, all except four have been recognized in the past ten years.2-4 While the intramural hematoma may arise spontaneously, it is much more frequently associated with trauma, usually from a nonpenetrating blow to the abdomen. In a review of 1,476 patients with blunt abdominal trauma resulting in intestinal injury, Poer and Woliver found that 8% involved the duodenum.5 The duodenum was especially vulnerable because of its retroperitoneal fixation and was the area involved in 50% of intramural hematomas described in 34 patients by Spencer et al.6

The roentgen diagnosis of intramural hematoma was beautifully illustrated by Liverud in 1948,7 while Felson and Levin8 described the pathognomonic "coiled spring" pattern of the mucosa as an aid in preoperative diagnosis in 1954. The patient reported here had been