Spontaneous intramural small-bowel hematoma: Clinical presentation and long-term outcome

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.