Delgado Ramos Glenda M, Piovezani Ramos Guilherme, Cotter Thomas G
Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Case Rep. 2017 Sep 27;2017:bcr-2017-220439. doi: 10.1136/bcr-2017-220439.
Spontaneous intramural small bowel hematoma (SISBH) is a rare, acute abdominal condition, with increasing incidence in recent years. Excessive anticoagulation with vitamin K antagonists is the most common aetiology. We report the case of a large acute jejunal intramural hematoma in a patient with newly diagnosed acute myeloid leukaemia receiving chemotherapy and nilotinib. The patient presented with abdominal pain, haematochezia, acute anaemia and thrombocytopenia. CT of the abdomen and pelvis revealed SISBH. The patient was managed conservatively with supportive management and cessation of nilotinib therapy. The patient's symptoms improved, with subsequent CT imaging confirming resolution. This case highlights an uncommon cause of gastrointestinal bleed usually diagnosed only after radiological imaging. A correct diagnosis is important as SISBH usually responds to conservative measures, and may obviate the patient from unnecessary invasive investigations.
自发性肠壁内小肠血肿（SISBH）是一种罕见的急性腹部疾病，近年来发病率呈上升趋势。维生素K拮抗剂过度抗凝是最常见的病因。我们报告了一例新诊断为急性髓系白血病且正在接受化疗和尼洛替尼治疗的患者发生大型急性空肠壁内血肿的病例。该患者出现腹痛、便血、急性贫血和血小板减少。腹部和盆腔CT显示为SISBH。患者接受了支持性治疗并停用尼洛替尼治疗的保守治疗。患者症状改善，随后的CT成像证实血肿消退。该病例突出了一种通常仅在影像学检查后才能诊断的罕见胃肠道出血原因。正确诊断很重要，因为SISBH通常对保守治疗有反应，且可避免患者进行不必要的侵入性检查。
