Nonoperative treatment of duodenal hematomata in childhood

Blunt abdominal trauma, often apparently trivial in nature, may produce intramural hematoma causing complete duodenal obstruction. A child with abdominal pain, persistent vomiting and upper abdominal tenderness should be carefully questioned for a history of trauma. Prompt upper gastrointestinal x-rays will allow early and definitive diagnosis. Previously recommended treatment varies from immediate surgical intervention to observation followed by exploratory laparotomy at a later date. We have treated nine patients with duodenal obstruction caused by intramural hematoma of which eight were successfully managed with nasogastric suction and parenteral fluid administration. One patient had the hematoma evacuated at surgery. This report reviews our experience.