Giant duodenal hematoma in hemophilia A.

A 10-year-old boy presented with a 40hhistory of progressive epigastric and right hypochondrial pain, non-bilious vomiting, constipation and failure to pass flatus. There was no history of injury. He was known to have hemophilia A with recurrent bleeding (easy bruising, hemarthroses, intramuscular hematomas and prolonged wound bleeding) which responded to factor VIII therapy. His parents were consanguineous and he had a brother with hemophilia A. On examination, he was moderately dehydrated and there was no pallor or icterus. The temperature was 36.8°C, heart rate 102/minute, respiratory rate 20/ minute and blood pressure 124/84 mm Hg. Abdominal examination showed guarding and tenderness in the epigastrium and right hypochondrium. The liver dullness was preserved and the bowel sounds were sluggish.