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Review
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Korean J Med. 2006;71(1):243-243.
- A Case of Obstructing Duodenal Intramural Hematoma Treated by Endoscopic Internal Drainage
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Ki Hyun Choi, Kwang Hyun Ko, Chang-Il Kwon, Pil Won Park, Kyu Sung Rim.
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- A Case of Obstructing Duodenal Intramural Hematoma Treated by Endoscopic Internal Drainage
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경상대학교 의과대학 내과학교실1, 경상대학교 의과대학 영상의학과 교실2
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- Abstract
- A Case of Obstructing Duodenal Intramural Hematoma Treated by Endoscopic Internal Drainage * Ki Hyun Choi, Chang-Il
Kwon, Kwang Hyun Ko, Pil Won Park, Kyu Sung Rim. Department of Internal Medicine, Bundang CHA General Hospital,
College of Medicine, Pochon CHA University Complicating intramural hematoma is an interesting, relatively unusual condition.
Most intramural hematomas resolve spontaneously with conservative treatment, and the prognosis of patients is good. However,
if symptom and sign does not resolve or complication persist, surgical intervention may become necessary. We report the first
case of an endoscopic internal drainage for the treatment of an intramural hematoma of duodenum. A 63-year-old woman was
admitted to our hospital with fresh hematemesis. She had been undergone hemodialysis three times a week due to diabetic
nephropathy. Esophagogastroduodenoscopy (EGD) revealed multiple ulcers with active bleeding in the duodenal bulb, and
sclerotherapy with fibrin glue was performed. Three days after EGD, she complaint of severe abdominal pain and vomiting.
Computed tomography (CT) showed a huge intramural hematoma, 10 x 5cm in diameter, at the lateral duodenal wall. Intramural
hematoma completely obstructing the lumen of the second portion of duodenum was noted on EGD. Although with continuing
conservative management, her symptom and sign did not improved. We decided to manipulate the hematoma endoscopically, and
puncture and incision with needle knife was done. Two days after the procedure, the patient tolerated to soft diet without
complaining abdominal pain and vomiting. The hematoma disappeared completely on follow-up CT and EGD. was rapidly
improved. Complicating intramural hematoma may be developed with endoscopic procedure and can be treated with endoscopic
internal drainage, successfully.
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