Small bowel intramural hemorrhage


This patient  had a known cardiac history and was on Warfarin. She presented with acute onset severe abdominal pain and signs of bowel obstruction. 

The CT findings demonstrate smooth uniform thickening along with close approximation of small bowel folds within a long segment of the proximal jejunum, giving the 'stack of coins' appearance. This is consistent with a diagnosis intramural hemorrhage secondary to anticoagulant therapy.

The differential for this appearance includes the Hidebound sign of systemic sclerosis, which refers to the appearance of tightly packed valvulae conniventes without significant thickening of the bowel wall. 

There is no follow up imaging available.