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Spontaneous intramural small bowel haemorrhage: importance of non-contrast CT
M J Lane1, D S Katz, R E Mindelzun
1Department of Radiology, Stanford University School of Medicine, California, USA.
Insights
Non-contrast abdominal CT scans are crucial for diagnosing spontaneous intramural small bowel hemorrhage, especially in patients with coagulopathy. These scans reveal key findings like hyperattenuation, which may be missed on contrast-enhanced imaging alone.
Area of Science:
- Radiology
- Gastroenterology
- Abdominal Imaging
Background:
- Spontaneous intramural small bowel hemorrhage is a rare condition.
- Patients often have underlying coagulopathies.
- Diagnosis can be challenging with standard imaging protocols.
Purpose of the Study:
- To evaluate computed tomography (CT) findings in patients with spontaneous intramural small bowel hemorrhage.
- To determine the utility of non-contrast CT in diagnosing this condition.
Main Methods:
- Retrospective review of abdominal CT scans from six patients.
- All patients had confirmed intramural small bowel hemorrhage.
- CT examinations were performed without oral or intravenous contrast media.
Main Results:
- Non-contrast CT scans revealed hyperattenuation in the affected bowel segments.
- Thickened and dilated proximal small bowel were consistently observed.
- These findings were diagnostic in all evaluated cases.
Conclusions:
- Non-contrast abdominal CT is highly effective for diagnosing spontaneous intramural small bowel hemorrhage.
- It is recommended for at-risk patients before contrast-enhanced scans.
- Non-contrast imaging provides definitive diagnostic information that may be obscured by contrast media.
Abstract:
The purpose of this study was to evaluate the abdominal CT findings in patients with spontaneous intramural small bowel haemorrhage. We retrospectively reviewed the abdominal CT scans of six patients with known intramural small bowel haemorrhage. All of the patients had an underlying coagulopathy. All six patients underwent CT examinations without oral or intravenous contrast media. All six non-contrast CT scans showed hyperattenuation of the involved bowel segments, with thickened and dilated proximal small bowel. Therefore, patients who are clinically at risk for intramural small bowel haemorrhage should undergo a non-contrast CT scan of the abdomen prior to the routine oral and intravenous contrast-enhanced scan. In most cases the non-contrast scan will provide definitive diagnostic information which may not be evident from the contrast-enhanced scan alone.