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Pediatric Radiology

, Volume 44, Issue 4, pp 392–397 | Cite as

Duodenal haematoma following endoscopy as a marker of coagulopathy

  • Shema Hameed
  • Kieran McHugh
  • Neil Shah
  • Owen J. ArthursEmail author
Original Article

Abstract

Background

Intramural duodenal haematomas (IDHs) are a rare complication of endoscopic biopsy but can cause significant morbidity and mortality, including duodenal obstruction, hospitalization and needing intravenous feeding. They are extremely uncommon in those with normal haematology.

Objective

To describe the occurrence of IDHs following endoscopic biopsy in our institution.

Materials and methods

We identified three patients who developed a post biopsy IDH during an 18-month period (2010–2012) in a retrospective search of our hospital pathology and imaging databases.

Results

All three children had complex medical problems and presented with gastrointestinal symptoms including severe abdominal pain, reflux, poor feeding and abnormal gut transit time. All underwent normal upper GI endoscopy with duodenal biopsy. Following endoscopy, they presented with intermittent GI obstruction with severe abdominal pain, distension and bilious vomiting or symptoms of pancreatitis, had imaging features of IDH and were managed conservatively making a full recovery. Initial haematology including platelet counts were normal, but two children were subsequently found to have platelet dysfunction and the third to have an unclassified coagulopathy.

Conclusion

IDHs may be the presenting factor in children with unsuspected bleeding problems. We present these findings to raise awareness of the imaging features and clinical impact of these cases because better understanding of these risk factors may help to avoid these complications in children in the future.

Keywords

Endoscopy Complications Duodenal haematoma Coagulopathy Child Ultrasound Upper gastrointestinal series 

Notes

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Shema Hameed
    • 1
  • Kieran McHugh
    • 1
  • Neil Shah
    • 2
    • 3
  • Owen J. Arthurs
    • 1
    Email author
  1. 1.Departments of RadiologyGreat Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, University College of LondonLondonUK
  2. 2.Departments of GastroenterologyGreat Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, University College of LondonLondonUK
  3. 3.KU Leuven, TARGIDLeuvenBelgium

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