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Clinical Presentation and Long-term Outcome

Maher A. Abbas, MD; Joseph M. Collins, MD; Kevin W. Olden, MD; Keith A. Kelly, MD

Arch Surg. 2002;137:306-310.

Hypothesis  To review our experience with the treatment of patients with nontraumatic spontaneous intramural small-bowel hematoma. Our hypothesis was that this condition resolves spontaneously in most patients.

Design  A retrospective review of the records of 13 patients with nontraumatic spontaneous intramural small-bowel hematoma who presented to Mayo Clinic (Rochester, Minn; Scottsdale, Ariz; and Jacksonville, Fla) between January 1, 1983, and December 31, 2000.

Setting  A tertiary care medical institution.

Patients  Mean age at presentation was 64 years (8 men, 5 women). Patients presented with abdominal pain (13 patients), intestinal obstruction (11 patients), and biliary obstruction (1 patient). Mean duration of symptoms was 4 days. Eight patients were receiving anticoagulant therapy (mean international normalized ratio, 11.6). Only 1 patient was anemic at presentation, but 11 patients became anemic during hospitalization. Computed tomography established the diagnosis in all patients.

Main Outcome Measures  Short- and long-term outcomes obtained from clinical records and telephone interviews.

Results  Single and multiple hematomas were present in 11 patients and 2 patients, respectively. Two patients had an exploratory operation, but no bowel resection was performed. The other 11 patients were managed with bowel rest. Two patients died of sepsis related to their coexisting medical conditions, and 11 patients left the hospital without short-term complications. At follow-up (mean, 35 months), 4 patients had died of unrelated causes, and 7 were alive; none had recurrence of bowel hematoma or intestinal obstruction.

Conclusion  Nonoperative treatment of spontaneous small-bowel hematoma has a good outcome in most patients.

From the Departments of Surgery (Drs Abbas and Kelly) and Diagnostic Radiology (Dr Collins) and the Division of Gastroenterology and Hepatology (Dr Olden), Mayo Clinic, Scottsdale, Ariz.

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