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SonoPhile

12-year-old boy with Di George syndrome who presented with an abdominal mass caused by an iatrogenic duodenal hematoma associated with upper gastrointestinal obstruction and acute pancreatitis. The boy arrived in the emergency room for epigastric pain, nausea and vomiting that had occurred for about 24 h.

Duodenal hematoma in pediatric age

The patient’s clinical history and ultrasound examination are already sufficient to formulate the diagnosis, which must be timely to avoid the onset of serious complications. The prognosis is good, as most children undergoing conservative treatment recover within 3 weeks of diagnosis, and ultrasound, due to the absence of ionizing radiation and the speed of execution, is extremely useful in monitoring the resorption of duodenal hematoma.

Conclusion

  • Patient Details: 12-year-old boy with Di George syndrome and GERD

  • Symptoms: Epigastric pain, nausea, vomiting for 24 hours

  • Medical History: Recent upper gastrointestinal endoscopy, no signs of peritonitis on physical exam

  • Abdominal Exam: Palpable mass in the epigastric region

  • Laboratory Results:

    • Low hemoglobin (10 g/dl)

    • Leukocytosis with neutrophilia

    • Increased C-reactive protein, pancreatic amylase, and lipase

    • Slightly elevated direct bilirubin (0.36 mg/dl)

    • Normal platelet count, prothrombin time, and activated partial thromboplastin time

  • Imaging:

    • Ultrasound:

      • Elongated mass between pancreas head and hepatic hilum extending to left hypochondrium

      • Mixed echostructure without vascular signal

      • Distended gallbladder with biliary sludge

      • Gastrectasis with fluid stagnation and free peritoneal fluid

  • Diagnosis: Voluminous intramural hematoma of the duodenum due to recent endoscopy

  • Treatment:

    • Conservative treatment with nasogastric aspiration and parenteral nutrition

    • Serial control ultrasound examinations

  • Outcome: Complete resorption of the duodenal hematoma, patient clinically cured after 3 weeks

Credit to: Brillantino, C., Rossi, E., Baldari, D., Minelli, R., Bignardi, E., Paviglianiti, G., Restivo, G., Cangemi, M. A., Zeccolini, R., & Zeccolini, M. (2022). Duodenal hematoma in pediatric age: a rare case report. Journal of ultrasound, 25(2), 349–354. https://doi.org/10.1007/s40477-020-00545-9

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