Intramural Duodenal Hematoma and Acute Pancreatitis

Dear Sir,

We read with great interest the paper by T. L. Dugernier et al. entitled ”Duodenal air dissection secondary to intramural hematoma in necrotizing pancreatitis” [1]. We agree with the authors about the conservative approach to management of intramural duodenal hematoma, especially when the origin is nontraumatic. In addition, we would also emphasize the role of nasojejunal feeding in the case of necrotizing pancreatitis. We have also reported the successful nonsurgical treatment of intramural duodenal hematoma complicating acute necrotizing pancreatitis [2]. Although complete bowel obstruction may prevent the insertion of the jejunal feeding tube, sometimes, even in the case of near-total duodenal obstruction, it is feasible to traverse the narrowed segment allowing utilization of the beneficial effects of enteral nutrition [3] in the presence of serious, life-threatening conditions.

References

• 1 Dugernier T L, Breuskin F M. Duodenal air dissection secondary to intramural duodenal hematoma in necrotizing pancreatitis.  Endoscopy. 2002;  34 1024
• 2 Bodnár Z, Várvölgyi C, Tóth J. et al . Intramural duodenal hematoma complicating acute necrotizing pancreatitis.  Gastrointest Endosc. 2000;  52 791-793
• 3 Windsor A C, Kanwar S, Li A G. et al . Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis.  Gut. 1998;  42 431-435