Publication:

Spontaneous intramural hemorrhage of the terminal ileum leading to bowel gangrene in a healthy 37-year-old female: a comprehensive case report

Spontaneous intramural intestinal hemorrhage (SIIH) is a very unusual presentation. It is only associated with anticoagulant drug therapy, trauma, or coagulopathies. Terminal ileal involvement in a patient without any predisposing factors is an extremely rare presentation, and progression to bowel gangrene is even rarer. We report a 37-year-old woman with no known comorbidities, medications, or surgical history who presented to us with acute abdominal pain and vomiting. Contrast-enhanced computed tomography (CECT) revealed hypo-enhancing distal ileal loop with free air foci, few loculated collections and enhancing peritoneum in right iliac fossa with features of subacute intestinal obstruction. Clinical deterioration ensued despite conservative management. Exploratory laparotomy, revealed a 15 cm gangrenous terminal ileal segment. Resection with end ileostomy was performed. Although SIIH usually resolves with conservative management, deterioration may lead to ischemia of the bowel segment associated with obstruction and needs timely surgical intervention. Prompt recognition and timely decision-making are critical for preventing mortality.