Intramural hematoma of the jejunum. A case report.

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Two of the authors recently published an article on intramural hematoma of the duodenum (7) in which the literature on this condition was reviewed and a case was reported. Shortly after the appearance of this article an opportunity arose to examine a patient with an intramural hematoma of the jejunum. Intramural hematoma is more rarely seen in the jejunum than in the duodenum, and it seemed worthwhile to report this example, since there were roentgenographic changes which made it possible to establish the diagnosis preoperatively. Case Report C. F., a 52-year-old man, was admitted to The Buffalo General Hospital, Feb. 22, 1960, complaining of abdominal pain, nausea, and vomiting of about five days duration. The pain was crampy in nature at the onset, gradually developing into a generalized abdominal discomfort. The nausea and vomiting became less severe and were accompanied by abdominal distention. Nine weeks prior to the present admission, the patient had a coronary thrombosis and anticoagulant (Dicumarol) therapy was started. Four weeks later he experienced sudden lower abdominal pain, crampy in nature, which recurred several times in the course of the next few days, accompanied by constipation. He was hospitalized in another institution and Dicumarol was discontinued. Laxatives and bed rest relieved the pain. Prior to admission to The Buffalo General Hospital, anticoagulant therapy had again been started. On admission to The Buffalo General Hospital, the patient's temperature was 98.6° F., pulse 116, blood pressure 130/92, respirations 24. He appeared acutely ill and markedly dehydrated. The abdomen was moderately distended, somewhat tense, and diffusely tender. There was rebound tenderness. Peristaltic sounds were absent. On rectal examination, tarry stool was found. The rest of the physical findings were essentially within normal limits. Hemoglobin was 14.0 gm., and the white blood count 18,000, with 6 per cent band forms, 72 per cent filaments, 15 per cent lymphocytes, and 7 per cent monocytes. The urine was cloudy, with a specific gravity of 1.023, negative for sugar, protein +, containing 40 to 60 red blood cells. The blood urea nitrogen was 26, total proteins 5.9 (albumin 4.2, globulin 1.7), Na 145, K 4.6, Cl 89, CO2 15.1; bleeding time two minutes, clotting time three minutes, and prothrombin time “over two minutes.” A Cantor tube was inserted and hydration was started. At this time the gastrointestinal bleeding was attributed to hypoprothrombinemia. Vitamin K1 oxide (Mephyton) was administered intravenously, bringing the prothrombin time down to sixteen seconds. Conservative therapy was continued, with improvement of the clinical picture: progressive relief of abdominal pain, decrease of distention, and return of peristalsis. The hemoglobin was 10.3 gm. on the third day and 8.2 gm. on the fourth day. The Cantor tube was removed, and oral feedings were started. To correct the blood loss, 1,500 c.c. of blood was given.