Case Of the Week (COW) 05 April 2015
Jejunal hematoma
Findings
Dilated stomach,duodenum & proximal jejunum Collapsed distal small bowel loops & colon long segment circumferential smooth mural thickening, appearing hyperdense on plain CT ,seen involving dilated mid jejunal loops. Also note increased density of free fluid in pouch of douglas Answer: spontaneous intramural haematoma of the jejunum presenting with small bowel obstruction and hemoperitoneum.
Discussion
The patient is a known case of rheumatic heart disease, post mitral valve replacement & on warfarin for the past one year. Spontaneous intestinal intramural haematoma is an uncommon complication of warfarin therapy. Jejunum is commonest site, followed by ileum, duodenum and colon. Small bowel obstruction, often incomplete, is the commonest mode of presentation. CT Scan is the investigation of choice. Initial non-contrast scan will demonstrate high attenuation haemorrhage in the bowel wall. Confident diagnosis will help avoid unnecessary laparotomy. Conservative management with restoration of coagulation parameters leads to satisfactory recovery in most cases.
Contributed By:
Prof. Babupeter, Dr. Mohideen Ashraf, Dr. Worshim Khamrang
Barnard Institute of Radiology
Jejunal hematoma
Findings
Dilated stomach,duodenum & proximal jejunum Collapsed distal small bowel loops & colon long segment circumferential smooth mural thickening, appearing hyperdense on plain CT ,seen involving dilated mid jejunal loops. Also note increased density of free fluid in pouch of douglas Answer: spontaneous intramural haematoma of the jejunum presenting with small bowel obstruction and hemoperitoneum.
Discussion
The patient is a known case of rheumatic heart disease, post mitral valve replacement & on warfarin for the past one year. Spontaneous intestinal intramural haematoma is an uncommon complication of warfarin therapy. Jejunum is commonest site, followed by ileum, duodenum and colon. Small bowel obstruction, often incomplete, is the commonest mode of presentation. CT Scan is the investigation of choice. Initial non-contrast scan will demonstrate high attenuation haemorrhage in the bowel wall. Confident diagnosis will help avoid unnecessary laparotomy. Conservative management with restoration of coagulation parameters leads to satisfactory recovery in most cases.
Contributed By:
Prof. Babupeter, Dr. Mohideen Ashraf, Dr. Worshim Khamrang
Barnard Institute of Radiology