Ultrasonographic images of spontaneous intramural hematomas of the intestinal wall in two patients with congenital bleeding tendency.

Pavia, IRCCS Policlinico S. Matteo, p.le Golgi 3, 27100 Pavia, Italy. Received March 1, 1995; accepted May 8, 1995. G astrointestinal bleeding is a well-known event in patients suffering from congenital hemostatic disorders. In hereditary hemorrhagic telangiectasia it is the most frequent form of bleeding after epistaxis; in hemophilia the reported incidence varied from 10 to 25%. In contrast, spontaneous non traumatic hematoma of the digestive apparatus is a rare complication, characterized by pain mimicking abdominal tumor, gastric or esophageal obstruction, or acute obstructive disease of the intestinal tract. Massive or occult gastrointestinal blood loss is generally observed. Invasive and/or expensive procedures, such as endoscopy, CT-scan and or MRI, are often required to make a correct diagnosis. Ultrasonography is rarely used to search for hematomas of the intestinal wall, and no imagings are available in congenital bleeding disorders. Therefore the aim of this report was to show the ultrasonographic features of this complication observed in two patients and relate them to the clinical course of these patients. BS, a 47-year-old man, affected by severe hemophilia A (factor VIII < 1U/dL) with low titer of inhibitor (0.9 Bethesda Unit), was admitted to our Department for abdominal pain and subocclusive state mimicking appendicitis. Hemoglobin was 14.3 g/dL and blood was present in his stools. Radiologic evaluation of the abdomen evidenced dilated loops of the small intestine. Ultrasound examination of the right lower quadrant showed a thickening of the intestinal wall with intraluminal fluid (Figure 1). The favorable clinical outcome obtained through treatment with factor VIII concentrates which resulted in complete resolution of ultrasonographic and radiologic findings after a few weeks prompted us to make a diagnosis of spontaneous ULTRASONOGRAPHIC IMAGES OF SPONTANEOUS INTRAMURAL HEMATOMAS OF THE INTESTINAL WALL IN TWO PATIENTS WITH CONGENITAL BLEEDING TENDENCY