Spontaneous intramural small bowel hemorrhage hemophilia
Acute abdominal pain and distension
Portal phase CT study
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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.
Spontaneous intramural hemorrhage is a relatively rare complication of hemophilia and is invariably managed conservatively.
Signs of this on CT include:
Circumferential wall thickening,
And resultant intestinal obstruction (1).
Early diagnosis is of paramount importance, as most patients are treated conservatively.
- 1. Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR. American journal of roentgenology. 179 (6): 1389-94.