A Spontaneous intramural small bowel haematoma

N.K Sandamalee,W.A Epa,D.D Ranasinghe

doi:10.4038/sljr.v2i1.22

Abstract

Spontaneous haemorrhage into small bowel wall leading to obstruction is a rare acute presentation among haemophilic patients. We present a case of a 46 year old male with haemophilia B, admitted to the surgical casualty ward with an acute abdominal pain suspicious of small bowel obstruction which was confirmed on erect abdominal radiograph and abdominal sonography. Contrast enhanced CT [CECT] abdomen revealed a segment of circumferentially thickened small bowel wall suggestive of bowel wall heamatoma. However, mild but appreciable contrast enhancement of the affected bowel wall raised the possibilities of a neoplastic or inflammatory process as differentials. Subsequent surgical intervention with resection of bowel after correction of factor IX and histology revealed intramural heamatoma of small bowel with no evidence of an inflammatory or neoplastic process. We believe that the bowel wall enhancement in CECT could be attributed to the enhancement of intact mucosa and sub mucosa predominating over non enhancing heamatoma which can be considered a diagnostic pitfall.

Highlights

Non traumatic spontaneous small bowel heamatoma is a rare occurrence[1,4]
Sonographic appearance of acute bowel wall heamatoma is described as thickened echogenic submucosa[1]
The CECT findings are reported as homogenous symmetrical intramural thickening

Summary

Introduction

Non traumatic spontaneous small bowel heamatoma is a rare occurrence[1,4]. It is more common in patients receiving anticoagulation or with bleeding disorders[1,3]. Non traumatic spontaneous small bowel heamatoma is a rare occurrence[1,4]. Computed tomography (CT) is the imaging technique of choice which shows mural hyper-density in a circumferentially thickened small bowel segment[1,3,4]. Urgent erect X ray abdomen showed multiple air fluid levels (>3, each >3cm) suggesting intestinal obstruction (Figure 1) and the ultrasound scan (USS) of the abdomen showed a long segment of small bowel with absent peristalsis and thickened wall.

Results

Conclusion