Spontaneous intramural small bowel hemorrhage
A male presented with acute abdominal pain. He has a history of coronary artery bypass grafting (CABG) surgery.
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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 edema 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 ischemia and submucosal hemorrhage. Differential diagnosis includes Crohn disease and infectious enteritis.
The patient underwent surgery. Surgery confirms submucosal jejunal hematoma on left with hemoperitoneum.
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 ischemia from intramural hematoma or inflammation difficult.
A combination of history, physical examination, and imaging findings are all important in establishing the correct diagnosis.