Imaging diagnosis and sequential conservative treatment of pediatric traumatic duodenal intraluminal hematoma

Aim: To explore the imaging, diagnosis, and treatment of traumatic duodenal intramural hematoma in children, improve diagnostic accuracy, and shorten hospitalization time. Methods: A retrospective analysis of five children with traumatic duodenal intramural hematoma. Results: One child had a descending duodenal wall hematoma, two had horizontal wall hematomas, one had an ascending wall hematoma, and one case involving both the descending and ascending parts. All five children were initially diagnosed by computed tomography (CT). The typical images showed "ice melting sign" and "fissure sign," with no lesion enhancement. Magnetic resonance imaging (MRI) in two children on follow-up showed spindle-shaped or quasi-circular intestinal walls protruding towards the intestinal lumen, local intestinal lumen stenosis, high signal intensity on T1W1 and uneven high signal intensity on T2W1, with no enhancement of the lesion. All five patients underwent multiple dynamic follow-up examinations using ultrasound, which clearly displayed the structure of the intestinal wall, absorption of hematoma, and the degree of intestinal obstruction. Conclusion: Conservative treatment, such as gastrointestinal decompression and intravenous nutrition, for pediatric duodenal wall hematoma has a good prognosis results in favorable outcomes. Initial CT diagnosis combined with multiple ultrasound follow-up has high specificity for the diagnosis and treatment of this disease.