Spontaneous intramural small bowel haemorrhage haemophilia

Case contributed by Dr Nolan Walker

Presentation

Acute abdominal pain and distension

Patient Data

Age: 75
Gender: Female
CT

Portal phase CT study

There is an abnormal concentrically thickened segment of small bowel in the pelvis with intramural hyperdensity.

In the clinical context represents a spontaneous intramural small bowel haemorrhage, secondary to the known diagnosis of haemophilia. 

There is mild small bowel luminal narrowing but there is no significant upstream or downstream small bowel dilatation to suggest obstruction.

In addition, there is free fluid in the pelvis and around the liver and spleen which probably represents blood.

There is no active bleeding demonstrated.

Case Discussion

Spontaneous intramural haemorrhage is a relatively rare complication of haemophilia and is invariably managed conservatively.

Signs of this on CT include:

Circumferential wall thickening,

Intramural hyperdensity

Luminal narrowing

And resultant intestinal obstruction (1).

Early diagnosis is of paramount importance, as most patients are treated conservatively.

 


 

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Case information

rID: 52389
Case created: 5th Apr 2017
Last edited: 27th Apr 2017
Inclusion in quiz mode: Included

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