Spontaneous intramural duodenal hematoma complicating acute pancreatitis.

A 49-YEAR-OLD MAN WHO is also a heavy drinker was referred to our hospital with sudden back pain and drowsiness. He had no history of anticoagulant use or trauma. He reported 1-week history of recurrent abdominal pain and vomiting after every meal. Physical examination revealed localized resistance with tenderness in the right upper abdomen. Laboratory examination revealed potassium, 2.5 mEq/L; urea nitrogen, 42 mg/dL; creatinine, 1.9 mg/dL; total bilirubin, 2.8 mg/dL; gamma-glutamyltransferase, 952 U/L; and amylase, 1,374 U/L; these values indicated acute pancreatitis. The International Normalized Ratio was within normal range. Arterial blood gases on room air were as follows: pH, 7.541; PO2, 56.1 mmHg; PCO2, 64.4 mmHg; base excess, 28.5 mmol/L; and bicarbonate 55 mmol/L, suggesting metabolic alkalosis. Abdominal contrast-enhanced computed tomography (CT) in the early phase revealed an nonenhancing intramural hematoma with luminal narrowing in the descending part of the duodenum and peripancreatic fluid