Colvin HS, Wato M, Sakakihara I, Akashi K, Okamoto K, Sui K, Nakamura S, Inaba T. Pancreatic adenocarcinoma complicated by intramural duodenal hematoma: A case report and review of literature. World J Gastroenterol 2026; 32(46): 122970 [DOI: 10.3748/wjg.122970]
Corresponding Author of This Article
Hugh Shunsuke Colvin, Consultant, Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu 760-8557, Kagawa, Japan. hughshunsukecolvin@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
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Colvin HS, Wato M, Sakakihara I, Akashi K, Okamoto K, Sui K, Nakamura S, Inaba T. Pancreatic adenocarcinoma complicated by intramural duodenal hematoma: A case report and review of literature. World J Gastroenterol 2026; 32(46): 122970 [DOI: 10.3748/wjg.122970]
Hugh Shunsuke Colvin, Masaki Wato, Ichiro Sakakihara, Kosei Akashi, Tomoki Inaba, Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
Kunio Okamoto, Department of Medical Oncology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
Kenta Sui, Department of Gastroenterological Surgery, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
Satoko Nakamura, Department of Pathology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
Author contributions: Colvin HS wrote the article, drafted the manuscript preparation, made an important contribution in revision; Wato M and Sakakihara I contributed to the writing, the table design and the analysis of the results and gave an important contribution in revision; Akashi K and Okamoto K contributed to the writing of the article, prepared figures and tables, revised all the bibliography; Sui K and Nakamura S lead in writing the discussion in manuscript; Inaba T conceived and designed the case report and revised the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: There was no contribution of AI in the preparation of this manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hugh Shunsuke Colvin, Consultant, Department of Gastroenterology, Kagawa Prefectural Central Hospital, 1-2-1 Asahimachi, Takamatsu 760-8557, Kagawa, Japan. hughshunsukecolvin@gmail.com
Received: May 6, 2026 Revised: June 11, 2026 Accepted: July 13, 2026 Published online: December 14, 2026 Processing time: 169 Days and 21.1 Hours
Abstract
BACKGROUND
Intramural duodenal hematoma is an uncommon condition that most frequently occurs secondary to blunt abdominal trauma. The development of intramural duodenal hematoma in patients with pancreatic cancer is exceedingly rare, and its clinical course in this setting remains poorly characterized.
CASE SUMMARY
Here, we report the first case in which the natural history of intramural duodenal hematoma associated with pancreatic cancer was observed beyond the early phase following initial presentation. In this case, the patient ultimately underwent pancreaticoduodenectomy after rebleeding of the hematoma increased the risk of further hemorrhage, which could have compromised the safe administration of neoadjuvant chemotherapy. We also reviewed the relevant literature and discuss the clinical challenges in the management of intramural duodenal hematoma in patients with pancreatic cancer.
CONCLUSION
Up-front surgery should be considered in similar cases due to the risk of rebleeding and limited evidence supporting neoadjuvant therapy.
Core Tip: Intramural duodenal hematoma in patients with pancreatic cancer is exceedingly rare. We report the first case in which the natural history of intramural duodenal hematoma associated with pancreatic cancer was observed beyond the early phase following initial presentation. In this case, the patient ultimately underwent pancreaticoduodenectomy after rebleeding of the hematoma increased the risk of further hemorrhage, which could have compromised the safe administration of neoadjuvant chemotherapy. In similar cases of resectable pancreatic cancer complicated by intramural duodenal hematoma, up-front surgery should be considered in light of the risk of rebleeding and the limited evidence supporting neoadjuvant therapy.
