Duodenal hematoma

Last revised by Mostafa El-Feky on 5 Oct 2023

Duodenal hematoma refers to hematoma formation in the duodenal wall, as the most common site of intramural hematoma of the gastrointestinal tract.

  • upper GIT obstruction: occurs in insidious onset at least 48 hours after injury. Nearly one-third of the patients present with obstruction

  • in setting of blunt abdominal trauma with other abdominal organ injuries

  • abdominal pain and tenderness

  • acute pancreatitis and direct hyperbilirubinemia due to obstruction of Ampulla of Vater

The duodenojejunal junction at the ligament of Treitz is a preferred site of traumatic intramural hematoma.

It occurs in isolation or with other abdominal organ injury. It may occur as a result of traumatic and non-traumatic settings



  • US typically reveals a uniform echogenic mass along the duodenal convexity

  • small intramural hematoma may present as intestinal wall thickening

  • obstruction of the duodenal lumen

  • an isolated hematoma will classically have heterogeneous high attenuationat 50–60 HU with narrowing of duodenal lumen

  • small hematomas appear as thickened duodenal wall

  • It usually causes narrowing or obstruction of its lumen

  • the duodenum is dilated proximal to the affected segment

  • fluid collection without contrast can be seen in both perforation and hematoma

  • MRI is used to detect early signs of bile duct dilatation and to exclude secondary pancreatitis

  • hematomas signals in MRI is similar to cerebral hematomas depending on its age

Duodenal hematoma is generally a nonsurgical injury. A hematoma in isolation can be treated conservatively: nasogastric tube decompression with resolution expected in 1-3 weeks.

  • lumenal narrowing: occlusion or stricture

  • biliary: pancreatitis and obstructive jaundice

  • hemodynamic: hemorrhage and shock

  • duodenal perforation

    • distinction must be made as it requires immediate surgical management

    • unfortunately, the distinction is not always easy radiologically and where diagnostic doubt persists, an exploratory laparotomy may be performed

  • search for other abdominal organ injury in setting of trauma: likel pancreatic, splenic, renal and liver injuries

  • fluid collection without contrast can be seen in both perforation and hematoma. Extravasation of oral contrast and/or extraluminal gas in the retroperitoneum (right anterior pararenal space) are specific for perforation

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Cases and figures

  • Case 1
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  • Case 1
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  • Case 2
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  • Case 3: with splenic injury
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