Presentation
Acute abdominal pain and distension
Patient Data
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 hemorrhage, secondary to the known diagnosis of hemophilia.
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 hemorrhage is a relatively rare complication of hemophilia 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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