Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure

Roseira, Joana; Cunha, Miguel; Sousa, Helena Tavares; Rachadell, J.; Brito, Jorge

Publication

Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure

2019Journal article

dc.contributor.author	Roseira, Joana
dc.contributor.author	Cunha, Miguel
dc.contributor.author	Sousa, Helena Tavares
dc.contributor.author	Rachadell, J.
dc.contributor.author	Brito, Jorge
dc.date.accessioned	2020-02-12T09:25:30Z
dc.date.available	2020-02-12T09:25:30Z
dc.date.issued	2019
dc.description.abstract	A 65-year-old man was evaluated for a difficult-to-characterize pancreatic head mass in the setting of idiopathic chronic pancreatitis. He had no other relevant medical history and was not taking any anticoagulant or antiplatelet treatment. Endoscopic ultrasonography fine-needle aspiration (EUS-FNA) failed to reveal neoplasm cells. A linear array echoendoscope (Olympus GF-UCT140, Center Valley, PA) was advanced up to the duodenal bulb, from which the head of the pancreas was visualized. After ensuring a vessel-free access to the pancreatic parenchyma, the FNA was performed using a 22G needle (Slimline 22G Handle Needle; Boston Scientific, Marlborough, MA) with a total of 3 passes (Figure 1). Three weeks after this procedure, the patient was admitted for hematemesis preceded by vomiting. On admission, his general physical examination was unremarkable except for jaundice. His blood tests showed no anemia; his platelet count, prothrombin time, amylase, and liver enzymes were within normal range, but his total bilirubin level was elevated (7.4 mg/dL). Upper gastrointestinal endoscopy showed Mallory-Weiss tears, an evident extrinsic compression of the knee, and the second portion of the duodenum, which could not be passed by the endoscope. The investigation by computed tomography and magnetic resonance cholangiopancreatography led to the diagnosis of an 11-cm intramural duodenal hematoma (IDH), leading to both gastric outlet and main biliary duct obstruction (Figure 2). The case was successfully managed with nasogastric decompression and exclusive parenteral feeding. Symptoms improved within 15 days, and cholestasis progressively disappeared.	pt_PT
dc.description.version	info:eu-repo/semantics/publishedVersion	pt_PT
dc.identifier.doi	10.14309/crj.0000000000000279	pt_PT
dc.identifier.eissn	2326-3253
dc.identifier.uri	http://hdl.handle.net/10400.1/13496
dc.language.iso	eng	pt_PT
dc.peerreviewed	yes	pt_PT
dc.publisher	Lippincott, Williams & Wilkins	pt_PT
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	pt_PT
dc.subject	Manegement	pt_PT
dc.subject	EUS	pt_PT
dc.title	Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure	pt_PT
dc.type	journal article
dspace.entity.type	Publication
oaire.citation.issue	11	pt_PT
oaire.citation.startPage	e00279	pt_PT
oaire.citation.title	ACG Case Reports Journal	pt_PT
oaire.citation.volume	6	pt_PT
person.familyName	Roseira
person.familyName	Sousa
person.givenName	Joana
person.givenName	Helena Tavares
person.identifier.ciencia-id	CF1F-1163-1C4A
person.identifier.orcid	0000-0002-5098-8729
person.identifier.orcid	0000-0002-6626-205X
rcaap.rights	openAccess	pt_PT
rcaap.type	article	pt_PT
relation.isAuthorOfPublication	077331f1-402e-455f-8e16-e475d62bc73a
relation.isAuthorOfPublication	6b1d11dd-486f-4fb3-b41f-02e1cf6a5c2e
relation.isAuthorOfPublication.latestForDiscovery	077331f1-402e-455f-8e16-e475d62bc73a