[Echography in the study of an intramural hematoma of the intestines]

Abstract

Purpose: To report our experience concerning the integrated diagnostic imaging of intestinal intramural hematoma, with special reference to the different patterns and to the accuracy of US examinations.

Material and methods: In the last 4 years we examined 7 patients with intraparietal hematoma, due to anticoagulant therapy, using real-time US. All the subjects presented with abdominal pain, sometimes associated with distention, tenderness, bleeding, hematocrit reduction, palpable mass or obstruction. The hematomas involved the duodenum in 2 cases, the jejunum in 4, and the descending colon in 1. US was performed in all patients, plain abdominal radiographs in 6, oral barium studies in 1, large bowel enema in 1, and computed tomography (CT) in 3. All patients were managed conservatively except the one with colonic location who was treated surgically.

Results: In all subjects, the US findings were characteristic and included clean and defined double- or multilayered thickening of the bowel wall (usually with a thick and hyperechoic inner layer and a thin and hypoechoic outer layer), undulated mucous membrane, narrowed lumen with corpuscolated fluid content and gas spots, decreased peristalsis with fixity of the images, fluid between the loops. Plain abdominal radiographs were relevant in 3 cases, showing focal intestinal distention, thickening of the intestinal wall and of the valvulae conniventes, bowel lumen narrowing and fixity of the findings. The findings were nonspecific/negative in the 2 subjects with duodenal involvement and demonstrated an intestinal obstruction in that with colonic location. Oral barium study did not provide, in the single patient examined with this tool, specific results, only causing time consumption and diagnosis delay. Barium enema was valuable in demonstrating the presence and level of the colonic obstruction due to the hematoma. Similarly to US, CT always demonstrated the intestinal changes, with a better panoramic detailing, but did not provide relevant additional information.

Conclusion: US shows a rather characteristic spectrum of findings in the intramural intestinal hemorrhage. The US data, possibly confirming plain abdominal radiographic findings, are in most cases relevant for the correct diagnosis of intraparietal hematoma and conclusive for the diagnostic course.