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Spontaneous Intramural Small-Bowel Hematoma: Imaging Findings and Outcome

Maher A. Abbas1, Joseph M. Collins2 and Kevin W. Olden3

1 Department of Surgery, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259.
2 Department of Diagnostic Radiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259.
3 Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ 85259.



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  		Fig. 1A. —84-year-old woman with atrial fibrillation who received excessive anticoagulation with warfarin (international normalized ratio, 10). Contrast-enhanced CT scan shows gastric and biliary obstruction. Dilated stomach (curved arrow), distended gallbladder (large straight arrow), and dilated bile and pancreatic ducts (small straight arrows) are evident.

 


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  		Fig. 1B. —84-year-old woman with atrial fibrillation who received excessive anticoagulation with warfarin (international normalized ratio, 10). CT scan shows unenhancing, large duodenal hematoma (arrow) causing obstruction.

 


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  		Fig. 2A. —73-year-old woman with atrial fibrillation who received excessive anticoagulation with warfarin (international normalized ratio, 6.8). CT scan with oral and IV contrast media shows jejunal hematoma with diffuse thickening of mucosal folds (arrows) with luminal narrowing.

 


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  		Fig. 2B. —73-year-old woman with atrial fibrillation who received excessive anticoagulation with warfarin (international normalized ratio, 6.8). CT scan with enteroclysis shows picket fence appearance of hematoma (arrow).

 


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  		Fig. 3A. —20-year-old woman with jejunal hematoma due to lupus vasculitis. Contrast-enhanced CT scan shows circumferential thickening in cross-section of jejunal wall with adjacent stranding of mesentery (arrow).

 


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  		Fig. 3B. —20-year-old woman with jejunal hematoma due to lupus vasculitis. Longitudinal CT scan of jejunal segment shows thickened mucosal folds (arrow).

 


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  		Fig. 4. —73-year-old woman with atrial fibrillation who received excessive anticoagulation with warfarin (international normalized ratio, 17.7). Contrast-enhanced CT scan shows jejunal hematoma with circumferential thickening of intestinal wall (arrow) and adjacent mesenteric stranding.

 


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  		Fig. 5. —86-year-old man with atrial fibrillation, previous cerebrovascular accident, and deep venous thrombosis who received excessive anticoagulation with warfarin (international normalized ratio, 12). Contrast-enhanced CT scan shows cross-sectional and longitudinal image of thickened wall of jejunum due to intramural hematoma (arrows).

 


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  		Fig. 6A. —70-year-old man with lymphoma, postchemotherapy pancytopenia, liver failure, and sepsis. CT scan shows extensive small-bowel intramural and intraluminal hemorrhage and hyperdense intramural and intraluminal hemorrhage in cross-section of jejunum (arrows). Hyperdense intraluminal hemorrhage is shown in longitudinal image of thick-walled jejunum (arrowheads). Neither oral nor IV contrast medium was administered. Hyperdense hemorrhage mimics oral contrast medium in bowel lumen.

 


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  		Fig. 6B. —70-year-old man with lymphoma, postchemotherapy pancytopenia, liver failure, and sepsis. CT scan shows layering of hemoperitoneum in pelvic cul-de-sac (arrows).

 


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  		Fig. 7. —51-year-old man with hemophilia, HIV, hepatitis C, and cirrhosis. Unenhanced CT scan shows circumferential thickening of terminal ileum with luminal narrowing and surrounding intraabdominal fluid. Arrow indicates ileal hematoma.

 


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  		Fig. 8. —64-year-old man with deep venous thrombosis who received excessive anticoagulation with warfarin (prothrombin time, 60 sec). After patient underwent left hemicolectomy for colon cancer, small intestine extends into fossa of descending colon. Contrast-enhanced CT scan shows cross-sectional view of jejunal intramural hematoma (white arrow) with adjacent dilated segment of jejunum and normal bowel wall (black arrow).

 

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