Iuchtman Miguel, Steiner Tzvi, Faierman Tzvi, Breitgand Alla, Bartal Gabriel
Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
Isr Med Assoc J. 2006 Feb;8(2):95-7.
Intramural duodenal hematoma generates partial or complete obstruction that develops slowly and progressively with a consequent delay in diagnosis. Many diagnostic and therapeutic measures remain debatable and justify a review of current management policy.
To highlight the diagnostic and therapeutic steps in pediatric IDH.
The records of 12 children with post-traumatic IDH who were treated in the Hillel Yaffe Medical Center between 1986 and 2000 were retrospectively reviewed. Three of them had clotting disorders and were excluded. The interval between their admission and diagnosis as well as the therapeutic decisions were evaluated and analyzed.
Nine children were treated for IDH. The interval between admission and diagnosis ranged from 24 hours to 6 days. Five children had associated traumatic pancreatitis. Initially, all the children were conservatively treated. In seven the hematoma resolved after 9-20 days. Two children were operated upon because the obstruction failed to resolve. All nine children recovered without permanent complications.
Intramural duodenal hematoma has many clinical and therapeutic puzzling aspects. Bicycle handlebar, road accidents and sports trauma are the main etiologic factors in children, but child abuse should be kept in mind. Associated traumatic pancreatitis is common. Gastroduodenal endoscopy may be useful to clarify doubtful cases. Pediatric surgeons should increase awareness regarding IDH in order to reduce delay in diagnosis and the need for surgical decompression.
十二指肠壁内血肿可导致部分或完全梗阻，其发展缓慢且呈进行性，从而导致诊断延迟。许多诊断和治疗措施仍存在争议，因此有必要对当前的管理策略进行综述。
强调小儿十二指肠壁内血肿的诊断和治疗步骤。
回顾性分析1986年至2000年在希勒尔·雅菲医疗中心接受治疗的12例创伤后十二指肠壁内血肿患儿的病历。其中3例有凝血障碍，予以排除。对他们入院至诊断的间隔时间以及治疗决策进行评估和分析。
9例患儿接受了十二指肠壁内血肿治疗。入院至诊断的间隔时间为24小时至6天。5例患儿伴有创伤性胰腺炎。最初，所有患儿均接受保守治疗。7例患儿的血肿在9至20天后消退。2例患儿因梗阻未缓解而接受手术治疗。所有9例患儿均康复，无永久性并发症。
十二指肠壁内血肿在临床和治疗方面存在许多令人困惑的问题。自行车车把伤、道路交通事故和运动创伤是儿童的主要病因，但应考虑到虐待儿童的情况。创伤性胰腺炎常与之相关。胃十二指肠内镜检查可能有助于明确可疑病例。小儿外科医生应提高对十二指肠壁内血肿的认识，以减少诊断延迟和手术减压的必要性。
