Điều trị tụ máu trong thành ruột non ở trẻ em: Nhân một trường hợp phẫu thuật bảo tồn thành công không cắt nối ruột

Abstract

Intramural small-bowel hematoma in children is a rare condition, most commonly associated with blunt abdominal trauma, whereas spontaneous cases occur primarily in patients with hemophilia. Most cases can be managed conservatively; however, surgery becomes necessary when complete intestinal obstruction develops. Although several reports recommend segmental resection with primary anastomosis, the indication for bowel resection remains controversial. We report a case of intramural small-bowel hematoma near the ileocecal valve successfully treated by enterotomy and evacuation of the hematoma without bowel resection. A 9-years-old boy presented with bowel obstruction 16 days after a bicycle handlebar injury to the abdomen. He had progressive abdominal pain, recurrent vomiting, and no response to conservative treatment. Physical examination revealed abdominal tenderness with lower abdominal ecchymosis. Abdominal radiography showed signs of obstruction, while computed tomography demonstrated a 7-cm intramural hematoma of the distal ileum near the Bauhin valve causing complete luminal obstruction. Enterotomy through the seromuscular layer and hematoma evacuation were performed without the need for resection. The patient recovered well without complication. Post-traumatic intramural small-bowel hematoma in children may lead to complete obstruction, and when conservative management fails, simple enterotomy with hematoma evacuation represents a feasible and bowel-preserving surgical option.