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G193(P) An unexpected, significantly large intramuralduodenal hematoma post upper gastrointestinal endoscopy and biopsy
  1. RS Parmar,
  2. S Tamhne
  1. Paediatric Gastroenterology Hepatology and Nutrition, Alder Hey Children’s Hospital, Liverpool, UK

Abstract

Aims/Introduction Upper gastrointestinal (GI) endoscopy is a common procedure for diagnostic and therapeutic purposes. Complications are usually rare and include bowel perforation and bleeding. We present an uncommon complication of post upper GI endoscopy, intramural duodenal haematoma (IDH). The incidence of IDH post biopsy not well established, but estimations are 1:1250 (both adult and paediatrics).

Method/Description of case A 6 year old girl with inflammatory bowel disease, vasculitis and primary sclerosing cholangitis. She was having poor response on Infliximab suggested by increasing blood and mucus in her stool, high faecal calprotectin and positive infliximab antibodies. A planned re-evaluation endoscopy and biopsy showed no evidence of significant inflammation apart from worm infestation. On day 2, she developed severe upper abdominal pain and persistent vomiting with blood. She was kept nil orally and started on iv fluids and antiemetics. Abdominal ultrasound showed an IDH involving first (D1) and second (D2) part of duodenum with narrowing of lumen. Intravenous omeprazole and NG sucralfate were added. She looked very pale too and FBC showed drop in haemoglobin from 81 to 57 for which she required blood transfusion. Platelet count and clotting were normal. She was discussed with our Surgical team who advised conservative management. On day 7, she had further clinical deterioration and a CT Abdomen confirmed a 75×74×68 mm size heterogeneous mass in D2 suggestive of IDH with no ongoing active bleeding. Following a 10 day course of parenteral nutrition and soft diet, she was weaned onto normal diet. In view of the unexpected significant large haematoma, a Haematological opinion was taken which found no haematological aetiology.

Result An unexpected large Intramural Duodenal hematoma post endoscopy and biopsy, managed conservatively.

Conclusion Upper GI endoscopy is described as a safe procedure routinely done as a day case. Our case had an extremely rare but known complication of a significantly large duodenal hematoma leading to symptoms of acute bowel obstruction, post endoscopy. The case highlights the need to keep a high suspicion for possibility of developing this complication and reiterates significance of careful radiological investigations in the post procedure period to avoid catastrophic consequences due to delay in confirming this diagnosis.

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