Spontaneous intramural small bowel hematoma in a patient with acute myeloid leukaemia receiving chemotherapy and nilotinib

Abstract

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.

Clinical features and outcomes in spontaneous intramural small bowel hematoma: cohort study and literature review

“…A literature review of the MEDLINE database identified 40 published articles within the previous 30 years, with a total of 103 cases with SISBH that were analyzed [6-34,36-46]. The mean age of patients with SISBH was 62.2 years.…”

“…In this study, however, all patients who presented with SISBH recovered after conservative management, without surgery. Recently, some reports showed that GI obstructive symptoms of SISBH could be treated conservatively without any sequelae, even in cases of extensively long segmental involvement of the hematoma [13,15,27,45,46]. Moreover, early detection of intramural hematoma is crucial because most patients with SISBH can be treated successfully without surgery [47].…”