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Medical Cases

December-2016

Star Imaging and Research Centre Medical case list

HISTORY

Case Courtesy:
Dr. Liteen Patil
  • 62 year old male with abdominal pain and vomittingfor 5-6 days
  • K/C/O DM and HTN
  • Had elevated creatinine levels at presentation
  • Known AF on Warfarin Therapy
  • Came for NCCT evaluation

FINDING & CONCLUSION

  • Segmental jejunal wall thickening
  • Hyperdensity of the thickened bowel wall
  • Hyperdense ascites (32 HU)
  • Mesenteric stranding and hyperdensity

Spontaneous Intramural small bowel hemorrhage

  • Usually affects elderly patients on anticoagulation therapy
  • Usually associated with INR more than 4
  • Jejunum followed by the ileum and duodenum are the most common sites in descending order of frequency
  • Bowel wall thickening/hyperdensity/hyperdense ascites -can clinch the diagnosis. This along with the clinical history of anticoagulation therapy
  • Resolution of the hematoma usually occurs in a few weeks
  • The triad of warfarintoxicity, circumferential thickening of the small bowel, and intestinal obstruction is characteristic of spontaneous intramural small-bowel hematoma