Spontaneous intramural small bowel haemorrhage

Case contributed by Ayaz Hidayatov
Diagnosis certain

Presentation

A male presented with acute abdominal pain. He has a history of coronary artery bypass grafting (CABG) surgery.

Patient Data

Age: 50 years
Gender: Male
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal C+ portal
venous phase
This study is a stack
Oblique MIP
reconstruction
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Info

CT reveals abnormal diffuse segmental wall thickening at the level of the jejunum (long segment, 18-20 cm) on the left side. There is mesenteric oedema and vascular congestion, and some ascites.

Superior mesenteric artery (SMA) and vein (SMV) are patent, and no thrombus was seen.

Findings are most suggestive of non-occlusive mesenteric ischaemia and submucosal haemorrhage. Differential diagnosis includes Crohn disease and infectious enteritis.

Case Discussion

The patient underwent surgery. Surgery confirms submucosal jejunal haematoma on left with haemoperitoneum.

The patient has a history of coronary artery bypass grafting (CABG) surgery and was taking anticoagulation medication. The absence of vascular occlusion and filling defect on CT imaging makes differentiation of ischaemia from intramural haematoma or inflammation difficult.

A combination of history, physical examination, and imaging findings are all important in establishing the correct diagnosis.

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