Idiopathic Duodenal Hematoma: A Case Report and Literature Review

TL;DR

A 60-year-old woman with no risk factors experienced a rare spontaneous duodenal hematoma, which was successfully treated without surgery.

Contribution

Presentation of a unique case of idiopathic duodenal hematoma without identifiable risk factors.

Findings

CT and MRI confirmed a spontaneous duodenal hematoma in a patient with no trauma or anticoagulant use.

Conservative treatment led to full resolution of the hematoma and recovery of the patient.

The case emphasizes the need to consider spontaneous hematoma in abdominal pain differential diagnosis.

Abstract

Background: Idiopathic duodenal hematoma is a rare clinical condition, typically associated with trauma, anticoagulation therapy, gastrointestinal procedures, or coagulopathies. We present a unique case of spontaneous duodenal hematoma in a patient without identifiable risk factors. Case presentation: We present the case of a 60-year-old Asian woman who presented to the emergency room (ER) with a 10-day history of progressive abdominal pain, early satiety, nausea, and vomiting. She had no history of trauma, anticoagulant use, or underlying predisposing conditions. On clinical evaluation, she was hemodynamically stable, and the initial laboratory results were unremarkable except for signs of dehydration and inflammation. A computed tomography (CT) scan revealed a heterogeneous lesion in the second portion of the duodenum, initially raising suspicion of a duodenal tumor. Further evaluation with magnetic resonance imaging (MRI) confirmed a duodenal hematoma with compression of the adjacent pancreas. Management and Outcome: The patient was managed conservatively with bowel rest, nasogastric decompression, intravenous (IV) fluid, and a proton pump inhibitor (PPI). Serial imaging demonstrated gradual hematoma resolution, with progressive improvement in her symptoms. She was discharged in stable condition and returned to normal activity after three weeks with complete hematoma resolution as seen on follow-up imaging. Conclusions: This case highlights the importance of considering spontaneous hematoma in the differential diagnosis of abdominal pain, even without risk factors. Early diagnosis and conservative treatment remain the mainstay of management and can lead to full recovery in uncomplicated cases.

Figures