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January 1988

Intramural Hematoma of the Duodenum

Author Affiliations

From the Departments of Surgery (Drs Jewett, Caldarola, Karp, Allen, and Cooney) and Pediatrics (Drs Jewett, Karp, and Cooney), and Section of Pediatric Surgery (Drs Jewett, Karp, Allen, and Cooney), The University at Buffalo, State University of New York; and Department of Pediatric Surgery, The Children's Hospital of Buffalo (Drs Jewett, Karp, Allen, and Cooney).

Arch Surg. 1988;123(1):54-58. doi:10.1001/archsurg.1988.01400250064011

• Intramural duodenal hematoma in children is one of the least common injuries encountered. Because of the rarity of this problem, there has been little conformity of opinion as to the relative merits of operative vs nonoperative management. We reviewed 182 cases of this condition, of which 168 were taken from the English literature and 14 from our hospital. Pancreatitis was the most common associated intra-abdominal lesion (21%), while central nervous system, skeletal, and thoracic injuries (5%) accounted for the major extra-abdominal injuries. Hemophilia, von Willebrand's disease, and idiopathic thrombocytopenic purpura occurred in 7 cases and played a major role in the prognosis. Of these cases, 121 patients were treated surgically and 61 conservatively. The average hospitalization was 14 days for the surgical group and 11 days for the conservative group. There were 18 complications in the surgical group. It appears that most patients with intramural duodenal hematoma would respond well to conservative management. Surgery should be reserved for those cases that remain obstructed over seven to ten days or have evidence of perforation.

(Arch Surg 1988;123:54-58)

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