Duodenal wall hematoma imitating a pancreatic tumor as a rare cause of obstructive jaundice - a case report.

Abstract

Obstructive jaundice is mostly caused by malignant lesions such as pancreatic head cancer and cholangiocarcinoma. Atypical benign conditions such as intramural duodenal hematoma (IDH), can imitate malignant processes in both clinical and radiological presentation. The diagnostic workup included computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) with biopsy. A 65-year-old patient was referred for assessment of obstructive jaundice and endoscopic retrograde cholangiopancreatography (ERCP). Initial presentation included hematemesis, anemia, cholestasis, and coagulopathy. Imaging (MRCP, CT) showed dilation of intra- and extrahepatic bile ducts and pancreatic duct, suggesting obstruction at the pancreatic head. CT also revealed a heterogeneous mass in the duodenum. ERCP demonstrated duodenal stenosis due to external compression and distal bile duct narrowing, and a self-expandable metal stent (SEMS) was inserted. Endoscopic ultrasound with biopsy revealed an intramural duodenal hematoma without malignant features. The patient's medical history was significant for multiple comorbidities and previous anticoagulation therapy. Follow-up imaging demonstrated complete regression of the hematoma, confirming its benign nature. The observed clinical course was consistent with spontaneous resolution; consequently, there was no need for surgical intervention. Intramural duodenal hematoma is a rare but important condition that may mimic pancreatic head tumors causing obstructive jaundice. Early detection using imaging techniques is critical to accurately establish the diagnosis. Early recognition facilitates conservative treatment and helps avoid unnecessary highly invasive surgical procedures.