case_images: PMC5778456_01
case_images: CT abdomen pelvis showing normal appearing pancreas (red arrow) with no hematoma around.
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case_images: PMC5778456_01_omx090f01.jpg
case_images: omx090F1
case_images: Computed tomography (CT) scan of abdomen showed uniform mural thickening of gastric antrum, and normal appearing pancreas (Fig. 1).
case_images: EGD revealed a brisk bleeding site in the second portion of the duodenum ~4 cm proximal to the ampula of Vater. Hemostasis achieved with 5 mL epinephrine and hemostatic clip.
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case_images: PMC5778456_01_omx090f02.jpg
case_images: omx090F2
case_images: The mucosa was edematous but without discernable ulcer (Fig. 2).
case_images: CT abdomen showing edematous appearing pancreas (red arrow) with a large duodenal intramural hematoma at the head of the pancreas (blue arrow).
case_images: omx090f03.jpg
case_images: PMC5778456_01_omx090f03.jpg
case_images: omx090F3
case_images: CT scan of abdomen showed an ill-defined, ovoid heterogeneous hyper attenuating structure distal to the hemostatic clip, expanding the second portion of the duodenum and measuring 5.5 x 3.8 cm2, most likely representing an intramural hematoma along with peri-pancreatic edema representing acute pancreatitis (Fig. 3).
case_images: CT abdomen showing resolving peri-pancreatic edema (red arrow) and resolving duodenal intramural hematoma (blue arrow).
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case_images: PMC5778456_01_omx090f04.jpg
case_images: omx090F4
case_images: A repeat CT scan of abdomen showed an interval decrease in size of the IDH and also the associated intra-peritoneal and extra-peritoneal hematoma (Fig. 4).