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From question on page 90

Endoscopic examination revealed marked ecchymosis in the first part of the duodenum with significant luminal compression consistent with a periduodenal haematoma. As the patient was clinically and haemodynamically stable, his conservative management was continued and his condition subsequently ameliorated. The haematoma rapidly resolved and his duodenum appeared entirely normal on a final endoscopic examination six months later.

Spontaneous haematomata surrounding the duodenum are unusual complications of anticoagulant therapy but may also occur after blunt abdominal trauma. Symptoms of gastric outlet obstruction may only become apparent sometime after the initial development of the haematoma (the mass effect of which increases as fluid shifts into the hyperosmotic degraded haematoma). A conservative approach to treatment is preferable as laparotomy and evacuation of the haematoma may exaggerate the injury to the viscus. Once suspected, a computerised tomogram or, more sensitively, a barium follow through contrast study should be performed to make the diagnosis and examine for mural perforation.

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