Sudden Onset of Intramural Duodenal Hematoma During Hemodialysis in Hypertensive Patient

A 79-year-old man undergoing treatment with warfarin for atrial fibrillation and hemodialysis for renal failure was transferred to our hospital for rehabilitation. During a maintenance hemodialysis session, blood pressure was shown to be elevated and an intramural duodenal hematoma suddenly occurred. After 3 days, the hematoma had enlarged and angiographic embolization was performed, with complete resolution noted after 2 months. Occurrence of an intramural duodenal hematoma during hemodialysis is rare. However, acute abdominal pain with symptoms indicating obstruction in patients undergoing such treatment should raise suspicion regarding an intramural duodenal hematoma. Although conservative treatment is often effective for a nontraumatic intramural hematoma, early angiographic embolization is preferred when disruption of anticoagulant therapy is difficult or for patients with failed medical treatment.