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

Table 1 Blood results at the time of first presentation

Laboratory test	Result	Reference interval
WBC	6900/μL	3300-8600/μL
Neu (%)	81.6%	42.0%-75.6%
Lym (%)	8.6%	17.4%-48.2%
Mon (%)	7.1%	3.4%-9.0%
Eos (%)	2.3%	0.4%-8.6%
Bas (%)	0.4%	0.2%-1.4%
RBC	511 × 104/μL	435-555 × 104/μL
Hb	16.3 g/dL	13.7-16.8 g/dL
Plt	25.1 × 104/μL	15.8-34.8 × 104/μL
PT INR	1.09	0.90-1.05
TP	7.5 g/dL	6.6-8.1 g/dL
Alb	4.2 g/dL	4.1-5.1 g/dL
Glb	3.3 g/dL	2.2-3.4 g/dL
T-BIL	12.9 mg/dL	0.4-1.5 mg/dL
D-BIL	8.5 mg/dL	≤ 0.4 mg/dL
AST	174 U/L	13-30 U/L
ALT	293 U/L	10-42 U/L
ALP	460 U/L	38-113 U/L
γ-GTP	1540 U/L	13-64 U/L
LDH	256 U/L	124-222 U/L
Amylase	181 U/L	44-132 U/L
Na	139.5 mmol/L	138.0-145.0 mmol/L
K	3.9 mmol/L	3.6-4.8 mmol/L
Cl	101.6 mmol/L	101.0-108.0 mmol/L
BUN	11.6 mg/dL	8.0-20.0 mg/dL
CRE	0.47 mg/dL	0.65-1.07 mg/dL
CRP	0.45 mg/dL	0.00-0.14 mg/dL
CEA	2.8 ng/mL	≤ 5.0 ng/mL
CA19-9	621 U/mL	≤ 37 U/mL
DUPAN-2	512 U/mL	0-150 U/mL
SPAN-1	143 U/mL	0-30 U/mL

WBC: White blood cells; RBC: Red blood cells; Hb: Hemoglobin; Plt: Platelet count; PT: Prothrombin time; TP: Total protein; Alb: Albumin; Glb: Globulin; T-BIL: Total bilirubin; D-BIL: Direct bilirubin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; γ-GTP: Gamma-glutamyltranspeptidase; LDH: Lactate dehydrogenase; BUN: Blood urea nitrogen; CRE: Creatinine; CRP: C-reactive protein; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9.

Table 2 Summary of pancreatic adenocarcinoma complicated by intramural duodenal hematoma

Ref.	Location of pancreatic cancer	Stage1 and size	Duodenal invasion	Prior history of trauma	Antithrombotic medication	Prior endoscopy	Location of duodenal hematoma	Contact between hematoma and tumor	Treatment
Tanaka et al[6], 2002	Head of the pancreas	pT1N0M0: 15 mm × 15 mm × 12 mm	No	Presumed	No	No	Second part, anterior wall	No	Pancreatico-duodenectomy
Chou et al[7], 2007	Uncinate process	30 mm × 30 mm × 28 mm	Yes	No	No	No	Second part, opposite to ampulla of Vater	Yes	Pancreatico-duodenectomy
Kitamura et al[8], 2013	Head of the pancreas (pancreaticoduodenal groove)	pT2N?M1, pStage IV: 30 mm × 30 mm × 25 mm	Yes	No	No	No	Second and third part	No	Pancreatico-duodenectomy
Khurana et al[9], 2014	Neck of the pancreas	pT1N1M0, pStage IIB 19 mm × 15 mm	No	No	Warfarin (for deep vein thrombosis)	No	Second part	No	Distal pancreatectomy
Nitta et al[10], 2019	Head of the pancreas	pT3N2M0, pStage III 60 mm	Yes	No	No	No	Second part	No	Pancreatico-duodenectomy
Current case	Head of the pancreas	pT2N2M0 pStage III 40 mm	Yes	No	No	ERCP, 11 days prior	Second and third part, opposite to ampulla of Vater	No	Pancreatico-duodenectomy

¹8^th edition Union for International Cancer Control classification of malignant tumors.

ERCP: Endoscopic retrograde cholangiopancreatography.