Spontaneous intramural small bowel haematoma and suburothelial haemorrhage

Case contributed by Dr Franco A. Scola

Presentation

Haematuria and bleeding gums. Deranged coagulation levels.

Patient Data

Age: 75 years
Gender: Male

Hyperdense and circumferential wall thickness of a small bowel segment causing luminal narrowing. There is no intestinal obstruction at present. Adjacent fat stranding. 

High-density mural thickness of the renal pelvic urothelium on the left, with minimal calyceal dilatation. Proximal left ureter is normal diameter but displays mild fat stranding.

No findings on the right kidney.

Free fluid in the pelvis.

Two main findings:

  • small bowel haematoma
  • suburothelial haemorrhage (left)

Case Discussion

This case demonstrates two rare complications of anticoagulation therapy. 

Spontaneous suburothelial pelvic and sinus haemorrhage usually presents as macroscopic haematuria and acute flank or abdominal pain. CT characteristics are mural thickening of renal pelvis and upper ureter that may cause calyceal dilatation. Unenhanced phase is recommended to detect this.

Non-traumatic small bowel haematoma usually presents with abdominal pain, intestinal obstruction or an acute abdomen. CT characteristics range from circumferential wall thickening, luminal narrowing, intramural hyperdensity and intestinal obstruction.

Other bleeding diatheses, for example, haemophilia and factor V deficiency, are associated with these findings.

Further medical investigation revealed that the patient overdosed on warfarin.

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Case information

rID: 50771
Case created: 20th Jan 2017
Last edited: 13th Feb 2017
Inclusion in quiz mode: Excluded

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