Sahn Benjamin, Anupindi Sudha A, Dadhania Neha J, Kelsen Judith R, Nance Michael L, Mamula Petar
*Division of Gastroenterology, Hepatology & Nutrition †Department of Radiology, The Children's Hospital of Philadelphia ‡Drexel University College of Medicine §Department of General Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):69-74. doi: 10.1097/MPG.0000000000000564.
Duodenal hematoma (DH) is a rare complication of esophagogastroduodenoscopy (EGD) with duodenal biopsy and uncommon, but better described following blunt abdominal trauma (BAT). We aimed to describe DH incidence and investigate risk factors for DH development post-EGD and compare its features to those post-BAT.
Multiple electronic databases were searched for the diagnosis of DH from 2000 to 2012. Inclusion criteria were patients 0 to 21 years of age who developed a DH following EGD with biopsy or BAT. Exclusion criteria were DH secondary to any other mechanism, EGD performed at another medical center, and insufficient information in the electronic medical record to determine treatments or outcomes.
A total of 14 post-EGD and 15 post-BAT patients with DH were included in the study. There were 26,905 EGDs with duodenal biopsies performed during the study period, for an incidence of 1:1922 procedures. Thirteen of 14 (93%) post-EGD DH events occurred between 2007 and 2012 (P < 0.001). The proportion of procedures performed under general anesthesia versus moderate sedation, and performed in the supine position versus left lateral decubitus were close to but did not reach statistical significance. DH-related complications and time to hematoma resolution was similar between groups.
In a 13-year study period, 14 patients developed DH after EGD, for an incidence of 1:1922. Method of sedation and supine positioning of the patient during endoscopy warrant further investigation as potential risks. The clinical course and time to recovery with conservative management are similar between patients with EGD and BAT-induced DH.
十二指肠血肿（DH）是食管胃十二指肠镜检查（EGD）及十二指肠活检的一种罕见并发症，在钝性腹部创伤（BAT）后虽不常见但有较多描述。我们旨在描述DH的发生率，调查EGD后发生DH的危险因素，并将其特征与BAT后的情况进行比较。
检索多个电子数据库，查找2000年至2012年期间DH的诊断情况。纳入标准为0至21岁在EGD活检或BAT后发生DH的患者。排除标准为继发于任何其他机制的DH、在其他医疗中心进行的EGD以及电子病历中信息不足无法确定治疗或结局的情况。
本研究共纳入14例EGD后和15例BAT后发生DH的患者。研究期间共进行了26,905次伴有十二指肠活检的EGD，发生率为1:1922次操作。14例EGD后DH事件中有13例（93%）发生在2007年至2012年之间（P<0.001）。全身麻醉与中度镇静下进行的操作比例，以及仰卧位与左侧卧位进行的操作比例接近但未达到统计学显著性。两组之间与DH相关的并发症及血肿消退时间相似。
在13年的研究期间，14例患者在EGD后发生DH，发生率为1:1922。内镜检查期间的镇静方法及患者的仰卧位姿势作为潜在风险值得进一步研究。EGD和BAT所致DH患者采用保守治疗的临床病程及恢复时间相似。
