Abstract
In a prospective study, all patients with peptic ulcer bleeding were documented between
February 1984 and April 1992. A total of 227 patients were treated by local injection
of epinephrine followed by laser application and injection of polidocanol or fibrin
tissue adhesive. In five of these patients, intramural hematomas developing at the
former bleeding site one to three days after endoscopic treatment were observed. The
presenting symptoms were abdominal pain, nausea, and vomiting. The diagnosis was established
by endoscopy, abdominal ultrasound, computed tomography, or laparotomy. In four of
our five patients, the bleeding site and hematoma were located in the duodenum. All
patients suffered from severe underlying diseases, and showed a clear disturbance
of coagulation parameters. In three patients, acute pancreatitis occurred concurrently
with the hematoma, probably due to obstruction of the papilla of Vater or compression
of the pancreas caused by the hematoma.
