Spontaneous haemorrhage into small bowel wall leading to obstruction is a rare acute presentation among haemophilic patients. We present a case of a 46 year old male with haemophilia B, admitted to the surgical casualty ward with an acute abdominal pain suspicious of small bowel obstruction which was confirmed on erect abdominal radiograph and abdominal sonography. Contrast enhanced CT [CECT] abdomen revealed a segment of circumferentially thickened small bowel wall suggestive of bowel wall heamatoma. However, mild but appreciable contrast enhancement of the affected bowel wall raised the possibilities of a neoplastic or inflammatory process as differentials. Subsequent surgical intervention with resection of bowel after correction of factor IX and histology revealed intramural heamatoma of small bowel with no evidence of an inflammatory or neoplastic process. We believe that the bowel wall enhancement in CECT could be attributed to the enhancement of intact mucosa and sub mucosa predominating over non enhancing heamatoma which can be considered a diagnostic pitfall.
How to Cite:
Sandamalee, N.K., Ranasinghe, D.D. and Epa, W.A., 2016. A Spontaneous intramural small bowel haematoma. Sri Lanka Journal of Radiology, 2(1), pp.22–26. DOI: http://doi.org/10.4038/sljr.v2i1.22