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

Sachin Kannaujiya; Manabendra Baidya; Amit Kumar Mishra; Samaksh Giri; Bhumika Gupta; Atul Kumar Gupta; Pallavi Singh

doi:10.18203/2349-2902.isj20260864

Authors

Sachin Kannaujiya Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Manabendra Baidya Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Amit Kumar Mishra Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Samaksh Giri Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Bhumika Gupta Department of Pathology, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Atul Kumar Gupta Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
Pallavi Singh Department of General Surgery, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20260864

Keywords:

Spontaneous intramural hemorrhage, Terminal ileum, Gangrene, Ileostomy, Acute abdomen, Small bowel ischemia

Abstract

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.

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