PMC5778456_01
CT abdomen pelvis showing normal appearing pancreas (red arrow) with no hematoma around.
omx090f01.jpg
PMC5778456_01_omx090f01.jpg
omx090F1
Computed tomography (CT) scan of abdomen showed uniform mural thickening of gastric antrum, and normal appearing pancreas (Fig. 1).
EGD revealed a brisk bleeding site in the second portion of the duodenum ~4 cm proximal to the ampula of Vater. Hemostasis achieved with 5 mL epinephrine and hemostatic clip.
omx090f02.jpg
PMC5778456_01_omx090f02.jpg
omx090F2
The mucosa was edematous but without discernable ulcer (Fig. 2).
CT abdomen showing edematous appearing pancreas (red arrow) with a large duodenal intramural hematoma at the head of the pancreas (blue arrow).
omx090f03.jpg
PMC5778456_01_omx090f03.jpg
omx090F3
CT scan of abdomen showed an ill-defined, ovoid heterogeneous hyper attenuating structure distal to the hemostatic clip, expanding the second portion of the duodenum and measuring 5.5 x 3.8 cm2, most likely representing an intramural hematoma along with peri-pancreatic edema representing acute pancreatitis (Fig. 3).
CT abdomen showing resolving peri-pancreatic edema (red arrow) and resolving duodenal intramural hematoma (blue arrow).
omx090f04.jpg
PMC5778456_01_omx090f04.jpg
omx090F4
A repeat CT scan of abdomen showed an interval decrease in size of the IDH and also the associated intra-peritoneal and extra-peritoneal hematoma (Fig. 4).