Pancreatic adenocarcinoma complicated by intramural duodenal hematoma: A case report and review of literature

Figure 1 Abdominal contrast computed tomography. A: Abdominal contrast computed tomography in the coronal plane showing an ill-defined 40 mm hypovascular mass at the head of the pancreas (arrows), together with dilatation of the common bile duct (arrowhead); B: Abdominal contrast computed tomography in the coronal plane revealing a high-density mass in the second part of the duodenum (arrows), consistent with a hematoma in the wall of the duodenum.

Figure 2 Upper gastrointestinal endoscopy. A: Upper gastrointestinal endoscopy showing a smooth red swelling arising from the subepithelial layer from the superior duodenal angle on the opposite side of the ampulla of Vater, consistent with an intramural duodenal hematoma; B: The duodenal lumen was narrow because of the subepithelial swelling; C: The contrast was able to pass without significant impedance to the jejunum.

Figure 3  Abdominal computed tomography in the coronal plane showed the enlargement of the intramural duodenal hematoma, consistent with a rebleed (arrows).

Figure 4  In the resected specimen, the hematoma (white circle) was separate from the tumor at the head of the pancreas (yellow circle) and the ampulla of Vater.

Figure 5  Histopathology of the resected specimen showed that the hematoma was located mainly within the muscularis propria, but in one area, there was only the subserosa (arrowhead) covering the hematoma (arrow).