Yeung Victor Hip-Wo, Chao Nicholas Sik-Yin, Leung Michael Wai-Yip, Kwok Wing-Kin
Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth Hospital, Hong Kong.
Pediatr Rep. 2009 Jun 8;1(1):e8. doi: 10.4081/pr.2009.e8.
A 15-year-old boy presented with intestinal obstruction two weeks following a blunt abdominal trauma. He had progressive bilious vomiting without abdominal distension or peritonitis. The contrast computed tomography (CT) scan of the abdomen provided the definitive diagnosis: there was an obstructing duodenal hematoma, which might have been slowly progressing or have arisen from secondary hemorrhage after the initial injury. The boy remained stable over a ten-day period of conservative treatment, and his obstructive symptoms and signs were resolved completely. A follow-up CT scan of the abdomen (16 days after admission) showed an almost complete resolution of the hematoma. Delayed duodenal hematoma causing intestinal obstruction has been reported rarely in previous literature. Occasionally a significant secondary hemorrhage resulting in intestinal obstruction can become life threatening. Clinical follow-up is paramount after initial recovery. Although conservative treatment suffices in most cases, the surgeon should be wary of the need for definitive surgical intervention if there is evidence of ongoing acute hemorrhage or of the obstructing hematoma failing to resolve. Laparoscopic drainage of the hematoma provides optimistic results for patients failing conservative management.
一名15岁男孩在腹部钝性创伤两周后出现肠梗阻。他有进行性胆汁性呕吐，无腹胀或腹膜炎。腹部对比计算机断层扫描（CT）明确诊断为：存在梗阻性十二指肠血肿，可能是缓慢进展或由初始损伤后的继发性出血引起。该男孩在为期十天的保守治疗期间病情稳定，梗阻症状和体征完全消失。腹部随访CT扫描（入院16天后）显示血肿几乎完全消退。以往文献中很少报道延迟性十二指肠血肿导致肠梗阻。偶尔，严重的继发性出血导致肠梗阻可能危及生命。初始恢复后临床随访至关重要。虽然大多数情况下保守治疗就足够了，但如果有持续急性出血或梗阻性血肿未消退的证据，外科医生应警惕是否需要进行确定性手术干预。对于保守治疗失败的患者，腹腔镜引流血肿可取得乐观效果。
